Key Points Enhanced recovery protocols for colorectal surgery have been widely adopted because of their success in reducing length of hospital stay and complications. Quality improvement efforts, including enhanced recovery, face significant barriers requiring persistence and redirection to achieve desired…
Key Points Perioperative medicine/care is multidisciplinary and covers the whole pathway from moment of contemplation of surgery to full recovery. Perioperative medicine and perioperative care are synonymous in many countries (but not all). Base training (e.g., nurse, physician, or physiotherapist)…
Key Points Patient experience in the perioperative setting is increasingly important, driven by the growing complexity of medicine and aging of the population. The same principles of high reliability that have markedly improved safety can be used to improve patient…
Key Points Healthcare quality is high, and costs are low in Michigan. The Continuous Quality Improvement (CQI) platform is a statewide learning health system that informs a physician-led, value-based reimbursement scheme. The quality agenda in Michigan is outsourced to the…
Key Points The leader can help set the culture and the vision for the organization. Effective leadership creates “psychological safety” for all team members to perform optimally. Classic change models are described with the key first step being creating urgency.…
Key points Urgency is not always about going fast. Provide some breathing room and allow the team to co-create their own ideas for success. The ideal temperature for forward change is in the “productive range of distress,” not too hot…
Key points Psychological safety and “humble inquiry” are the foundation and scaffolding for successful, productive, learning teams. A strong team is even stronger when interpersonal relationships are valued. Mental rehearsal and planning an engagement strategy before important meetings are important…
Key points The importance of context to the fate of healthcare improvement is well acknowledged but inconsistently studied and understood. Social scientific methods and theories offer an important resource for understanding contextual and social influences. Conceptual frameworks help to provide…
Key points Perioperative safety checklists exist for both routine (e.g., safety pause before case start) and nonroutine situations (e.g., perioperative critical events). Insight from the implementation sciences has been used to determine the best strategies to determine how to foster…
Key Points A checklist is a complex sociotechnical intervention that requires careful attention to instrument design, implementation, and identification of essential task-oriented skills. Successful implementation of checklists must leverage human factors engineering and implementation science principles to promote “stickiness,” or…