Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Checklists for Safer Perioperative Care

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 use of perioperative checklists, when indicated. Perioperative safety checklists can benefit not only the patient but also healthcare professionals at the individual, team, and system level.…

Human Factors and Perioperative Improvement: Handover Checklists and Protocols for Safe and Reliable Care Transitions

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 habit formation, and to mediate successful culture change. Creating a standardized handover checklist and following a structured process for handover increases the accuracy of information transferred,…

Human Factors in Perioperative Care: General Principles

Key Points Human factors (HF) is a scientific discipline that uses observation and analysis of work processes to identify opportunities for improvement and design interventions to implement these. HF differs from standard quality improvement (QI) in its reliance on systematic analysis of work using standardized tools and in its focus on the humans in the system. HF shares with QI a belief in the importance of…

Care Bundles for Perioperative Improvement

Key Points Care bundles provide a means of grouping a small number of evidence-based components together for a defined patient group or setting of care to facilitate a desired and improved outcome. The processes, when grouped into a bundle, should have a synergistic impact compared with individual use. The processes in the care bundle should be delivered regularly and highly reliably. An effective bundle should have…

Driver Diagrams

KEY POINTS A driver diagram demonstrates the factors underlying a particular outcome. It can offer a visual representation of the “theory of change” underpinning the improvement work. A driver diagram is useful for generating change ideas that directly link to a desired outcome. It is a simple but effective tool to develop and communicate a quality improvement project with team members. It can help organize the…

Process Mapping

Key Points Process maps provide a useful tool to help understand a system and stimulate improvement ideas. Process maps are a visual representation of a process or pathway broken down into the constituent steps and options along the pathway. Creating a process map should involve key stakeholders across the process. A perioperative process map is most useful if it includes patients to give important insights into…

Statistical Process Control Charts for Clinical Users

Key points Quality improvement teams need a rigorous method to learn whether the changes they make lead to improvement. Statistical process control (SPC) charts visualize data over time, signaling whether a process is stable or whether a nonrandom special cause, suggesting improvement or deterioration, has occurred. A variety of SPC charts are available depending on the attributes of the measure. Quality assurance teams can use SPC…

Analyzing Variation With Run Charts

Key Points Variation exists in all that we do. Variation needs to be understood as it lays itself out over time. Static displays of data using summary and descriptive statistics will not allow you to understand variation. The Run Chart provides a starting point to understand variation in a process. In the previous chapter, six of the milestones in the quality measurement journey (QMJ) were discussed.…

Building a Measurement System That Works: Milestones, Measure Development, and Sampling

Key Points Without data, you are merely a person with another opinion! Living in concept-land will never produce results! The milestones in the quality measurement journey provide the roadmap for successful results. Every successful journey starts with a map and a plan. As the milestones along the journey are approached and passed, the traveler has an opportunity to assess progress made toward the journey's destination. Quality…

Other Performance Improvement Tools: From Compliance to Excellence

Key Points Improving healthcare processes and outcomes and maintaining these achievements within the healthcare system is a multifaceted journey. Different services, systems, and processes each present their own unique set of “Opportunities for Improvement” (OFI). Depending on the complexity of the OFI—and, equally important, the level of organizational maturity—the approach used is different. Improving healthcare processes and outcomes and maintaining these achievements within the healthcare system…

The Model for Improvement: A Tool to Drive Perioperative Improvement

Key Points The Model for Improvement provides a template to test, implement and study change. To drive improvement, bold, specific, time-bound, aligned, ambitious, and numeric aims must be developed. Measurement is central to a team's ability to monitor and improve care. Not all changes will result in improvement. Diagnose what is wrong with the system that requires improvement and then develop a theory of change. Use…

An Overview of Common Improvement Methodologies and Their Background

Key Points Description of the quality improvement (QI) methodology used is essential to ensuring the process can be replicated. The most common QI methodologies are Six Sigma, Lean Thinking, Model for Improvement, Statistical Process Control, and Theory of Constraints. It is important to recognize the key features of each QI methodology to differentiate between them. There is no superior QI methodology; success is rooted in implementation…

What is Program Theory and Why Is It Important to Perioperative Quality Improvement?

Key points The planning of quality improvement greatly benefits from articulating a program theory: It improves clarity around what the intervention is attempting to accomplish and the mechanisms of change. A program theory can also identify stakeholders and conditions for success. A program theory is based on the principle that the design and implementation of interventions are a reflection of underlying assumptions about a particular problem…

Using Innovative Payment Models to Drive Improvement in Perioperative Care

Key Points All payment models fundamentally seek to leverage financial incentives for healthcare organizations, providers, and patients to drive behavior changes that reduce spending on healthcare services and improve health outcomes. Understanding the basic design of payment models is necessary to take advantage of new opportunities to improve perioperative care. Episode-based bundled payment models are one of many innovative models that may impact perioperative care. Payment…

Risk Management and Perioperative Quality

Key points The medical malpractice system does a poor job of improving patient safety and quality. Targeted risk reduction initiatives are associated with lower malpractice costs. Initiatives can be tailored to individual departments or expanded entity-wide. Successful areas of focus include improving physician-patient communication, educating clinicians on the basics of medical malpractice, and developing procedure-specific electronic informed consent documents. Healthcare risk management includes a number of…

Building for Sustainability

Key points ▪ Create passion for change and link to everyone's values. ▪ Team engagement, involvement, and ownership is essential to achieve and sustain change. ▪ Continuous transparent measurement must be established from the beginning. ▪ Maintain compliance measures and regular review, even after the aim is achieved to ensure success continues. ▪ Communicate and provide feedback on progress regularly. ▪ Ensure visible senior leadership and…

Leveraging the Perioperative Period to Address Population Health

Key points Population health in the United States lags behind that of its peers. Undergoing major surgery serves as a teachable moment in which patients are especially motivated to adopt risk-reducing health behaviors. Perioperative interventions that screen for and intervene on modifiable health behaviors are feasible to implement and may significantly improve long-term outcomes. Health systems can take practical steps to integrate available resources into the…

The SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) Guidelines: A Framework for Designing and Reporting Quality Improvement Studies, Application in Perioperative Care

Key points The SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guidelines provide a framework around which to construct and report an improvement project. The guidelines provide a format recognized by mainstream journals for the reporting of quality improvement studies. Background As quality improvement (QI) studies have become more widespread and researchers try to get studies published, the need for a structured method of formulating a…

Publication in Perioperative Medicine

Key points Publication in perioperative medicine in a broad sense can be defined as work investigating the generation of value (quality ÷ cost) through the organization, operations, and metrics of care provided throughout the perioperative period. Publications in this area can include articles that are hypothesis driven with a scientific methodology ranging from randomized controlled trials to pre- and post-intervention work. Publications can also include work…