Quality Improvement can help surgeons to deliver better patient care

Why should we, as surgeons, learn about Quality Improvement (QI)? Perhaps because a surgeon’s paradigm is to focus on the patient’s presenting problem, diagnose (often by going to the site of pathology), intervene (usually in a satisfyingly direct operative procedure), then follow up on our patient’s recovery, document our learning and share it. We like to make a difference. Definitively.

This is the same paradigm we use in Quality Improvement. To take one tried and tested methodology, Lean Six Sigma, we:
• Define the problem
• Measure the appropriate parameters
• Analyse the current situation, understand the root cause(s)
• Improve, by applying appropriate countermeasures, and finally
• Control the system we have improved with appropriate follow-up and monitoring

Using this understanding, which chimes so well in our everyday work, disciplines us to take small steps to really make a difference, for good.

I was initially a reluctant student of Quality Improvement. I stumbled into it having trained as a human factors facilitator and was encouraged to do a Postgraduate Certificate in Improvement in Quality and Safety. I wanted to help embed good team working and safe procedures so that teams could get great results despite being made up of fallible and error-prone human beings.

So I enrolled on my postgraduate certificate. I learnt by doing – by helping to change the culture in a large hospital’s operating theatres, introducing reliable and productive briefing and debriefing. Since then the practice has spread to many areas of team performance, and we have made a difference.

Some examples of achievements with this methodology include: more consistent theatre start times, improved theatre team working scores, improved booking process for emergency maternity cases, safer endoscopy (safety checks and briefing), reduced wait times for preoperative coagulation testing, reduced turnaround times for complaints and improved theatre utilization.

When I look back over my career, QI has been one of the most satisfying and productive roads I have taken. To be part of an improvement, which fixes something that hurts people, or damages teams, or wastes resources or, yes, kills people, is a powerful antidote to the learned helplessness which is creeping into our Health Service.

We have so much to learn from the pioneers of quality improvement. We are not reinventing the wheel. It’s like learning to do an operation, or take a great history. It’s a way of looking at systems and people which leads us to understand what’s going wrong and fix it.

I have worked with the Royal College of Physicians, helping to lead their “Learning to Make a Difference” programme. It’s been so satisfying to help young doctors take up the challenge of making change happen – and to see them “get it”. Their workplaces and indeed working lives will be much the richer for it. Our schedules are packed. We have so much to do. My challenge to you is – learn how to make it count. Make a difference.

Richard Berrisford is a Consultant Oesophagogastric Surgeon

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Quality Improvement is a practical way for all members of the surgical team to work together to improve patient care. The RCS recognises the importance of QI, and is committed to supporting surgeons and the wider surgical team which is why we've launched a quality improvement hub to help surgical teams improve the quality of care they provide and reduce the variability of patient outcomes. See what's new, visit the new quality improvement hub today.