The application of quality improvement methodologies in surgery

Abstract

Quality improvement (QI) practices were originally developed in the manufacturing industry to reduce unnecessary steps in a process, minimize error, and provide maximum benefit to the consumer. QI is defined as a formal approach to the analysis of performance and systemic efforts to improve it. QI methodologies have been adopted by industries outside manufacturing, including healthcare. In the healthcare environment, performance consists of many factors including patient safety, clinical results, and system efficiency. Given the publicly funded, limited resource environment in which the Canadian healthcare system operates, the practice of delivering safe, quality healthcare in an efficient and cost-effective manner is an important factor in promoting the economic viability and sustainability of the system. Surgical practice has been identified as an area in which QI methodologies can be applied, given its resource intensive nature and highly regulated environment. Current research supports the use of QI in surgery, with interventions showing improvements in non-operativetime, on-time starts, and operating room patient volume. Limitations to the application of QI include the heterogeneity of interventions and variability in terms of procedures and patient factors. Further high-quality studies are required to support evidence-based applications of QI in the surgical setting as well as the greater healthcare environment.