New planning tool aims to boost success of surgical quality improvement projects

Editor's Note

A newly developed framework could significantly strengthen the planning phase of small-scale surgical quality improvement (QI) projects, which often falter due to inadequate preparation, MedicalXpress October 16 reports. According to a report from the American College of Surgeons (ACS), published in the Journal of the American College of Surgeons, the Early Planning of Small-Scale Surgical Improvement (EPOSSI) framework was created to offer a structured, practical guide for clinicians leading QI efforts.

The tool emerged in response to research showing most surgical QI projects struggle at the outset. A prior review of 50 projects found just one met more than 70% of established criteria. Another review of 242 projects revealed widespread deficits in early-stage planning. Many projects, typically undertaken with goals like reducing mortality or length of stay, fall short despite well-intentioned teams.

Lead author Clifford Y. Ko, MD, FACS, senior vice president of the ACS Division of Research and Optimal Patient Care, said the framework is designed to help frontline clinicians “get the planning stage right” and ultimately achieve their improvement goals. The study tested EPOSSI’s effectiveness by asking participants to plan a QI project both with and without the framework.

Without guidance, participants’ plans met just 24% of the 26 planning criteria. Using the full EPOSSI tool, which includes a nine-step diagram and detailed guidance table, plans met 100% of criteria. This improvement was consistent across attending surgeons, residents, individual users, and teams.

EPOSSI was developed through a five-phase process involving literature review, clinician input, and a consensus-building exercise with more than 130 experts. The framework’s nine steps include assembling a team, defining aims, planning implementation and monitoring, making a go or no-go decision, and transitioning to delivery. It is designed to be used alongside any QI methodology and is intended as a simple checklist to ensure no critical planning components are overlooked.

Dr Ko compared the importance of strong front-end planning in healthcare to its proven impact in other fields like construction, where better planning has been shown to reduce costs and accelerate completion times. The framework is now available for use through the ACS website.