Understanding the influences on successful quality improvement in emergency general surgery: Learning from the RCS Chole-QuIC project

Timothy J. Stephens, Jonathan R. Bamber, Ian J. Beckingham, Ellie Duncan, Nial F. Quiney, John F. Abercrombie, Graham Martin, Jenny Abraham, Jawad Ahmad, Ibrahim Ahmed, Melanie Andrews, Barry Appleton, Mohammad Asif, Russell Bolton, Christopher Briggs, Uchihara Bumagat, Simon Burchfield, Gemma Cochrane, Ffion Dewi, George DovellSarah Dyer, Jemma Edge, Rachel Edwards, Ismay Fabre, Elizabeth Gemmill, Ewen Griffiths, Deepak Hariharan, Emma Harrington-Patel, Ahmed Hassn, Michael Hepworth, James Hewes, Sarah Hine, Marianne Hollyman, Kelly Ide, Deborah Jenner, Richard Johnson, Simon Jordan, Stavros Karamanakos, Joshua Kovoor, Neil Kukreja, Gabriele Marangoni, Nicola Metcalfe, Paul Morcous, Paul Needham, Niv Patel, Nabeel Qureshi, Niroshini Rajaretnam, Ilayaraja Rajendran, Yousuf Sabah, David L. Sanders, Andrew Sandison, Jennifer Sansom, Rashmi Seth, Vinutha Shetty, Tomas Sollei, Sean Strong, Laura Sullivan, Robert P. Sutcliffe, Lee Talbot, Gillian Taylor, Viju Varadarajan, Edward Villatoro, Judith Wardale, Simon Weaver, Tom Wiggins, Alexander Wood

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Background: Acute gallstone disease is the highest volume Emergency General Surgical presentation in the UK. Recent data indicate wide variations in the quality of care provided across the country, with national guidance for care delivery not implemented in most UK hospitals. Against this backdrop, the Royal College of Surgeons of England set up a 13-hospital quality improvement collaborative (Chole-QuIC) to support clinical teams to reduce time to surgery for patients with acute gallstone disease requiring emergency cholecystectomy. Methods: Prospective, mixed-methods process evaluation to answer the following: (1) how was the collaborative delivered by the faculty and received, understood and enacted by the participants; (2) what influenced teams' ability to improve care for patients requiring emergency cholecystectomy? We collected and analysed a range of data including field notes, ethnographic observations of meetings, and project documentation. Analysis was based on the framework approach, informed by Normalisation Process Theory, and involved the creation of comparative case studies based on hospital performance during the project. Results: Chole-QuIC was delivered as planned and was well received and understood by participants. Four hospitals were identified as highly successful, based upon a substantial increase in the number of patients having surgery in line with national guidance. Conversely, four hospitals were identified as challenged, achieving no significant improvement. The comparative analysis indicate that six inter-related influences appeared most associated with improvement: (1) achieving clarity of purpose amongst site leads and key stakeholders; (2) capacity to lead and effective project support; (3) ideas to action; (4) learning from own and others' experience; (5) creating additional capacity to do emergency cholecystectomies; and (6) coordinating/managing the patient pathway. Conclusion: Collaborative-based quality improvement is a viable strategy for emergency surgery but success requires the deployment of effective clinical strategies in conjunction with improvement strategies. In particular, achieving clarity of purpose about proposed changes amongst key stakeholders was a vital precursor to improvement, enabling the creation of additional surgical capacity and new pathways to be implemented effectively. Protected time, testing ideas, and the ability to learn quickly from data and experience were associated with greater impact within this cohort.

Original languageEnglish
Article number84
JournalImplementation Science
Volume14
Issue number1
DOIs
StatePublished - Aug 23 2019

Keywords

  • Breakthrough collaborative
  • Evaluation
  • Gallstone disease
  • Normalisation process theory
  • Quality improvement
  • Service improvement

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