Understanding the influences on successful quality improvement in emergency general surgery: learning from the RCS Chole-QuIC project
Creators: name: Stephens, Timothy J.
name: Bamber, Jonathan R.
name: Beckingham, Ian J.
name: Duncan, Ellie
name: Quiney, Nial F.
name: Abercrombie, John F.
name: Martin, Graham
name: Abraham, Jenny
name: Ahmad, Jawad
name: Ahmed, Ibrahim
name: Andrews, Melanie
name: Appleton, Barry
name: Asif, Mohammad
name: Bolton, Russell
name: Briggs, Christopher
name: Bumagat, Uchihara
name: Burchfield, Simon
name: Cochrane, Gemma
name: Dewi, Ffion
name: Dovell, George
name: Dyer, Sarah
name: Edge, Jemma
name: Edwards, Rachel
name: Fabre, Ismay
name: Gemmill, Elizabeth
name: Griffiths, Ewen
name: Hariharan, Deepak
name: Harrington-Patel, Emma
name: Hassn, Ahmed
name: Hepworth, Michael
name: Hewes, James
name: Hine, Sarah
name: Hollyman, Marianne
name: Ide, Kelly
name: Jenner, Deborah
name: Johnson, Richard
name: Jordan, Simon
name: Karamanakos, Stavros
name: Kovoor, Joshua
name: Kukreja, Neil
name: Marangoni, Gabriele
name: Metcalfe, Nicola
name: Morcous, Paul
name: Needham, Paul
name: Patel, Niv
name: Qureshi, Nabeel
name: Rajaretnam, Niroshini
name: Rajendran, Ilayaraja
name: Sabah, Yousuf
name: Sanders, David L.
name: Sandison, Andrew
name: Sansom, Jennifer
name: Seth, Rashmi
name: Shetty, Vinutha
name: Sollei, Tomas
name: Strong, Sean
name: Sullivan, Laura
name: Sutcliffe, Robert P.
name: Talbot, Lee
name: Taylor, Gillian
name: Varadarajan, Viju
name: Villatoro, Edward
name: Wardale, Judith
name: Weaver, Simon
name: Wiggins, Tom
name: Wood, Alexander
Publisher: name: Apollo - University of Cambridge Repository
Year: 2019
Subjects: Research
Quality improvement
Service improvement
Breakthrough collaborative
Gallstone disease
Evaluation
Normalisation process theory

description: 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.