A. R. Dahlke1, A. Yang1, J. Johnson1, K. O’Leary3, L. Kreutzer1, P. R. Farrell1, J. Thomas1, R. Love1, A. Halverson1, M. Williams2, K. Y. Bilimoria1 1Northwestern University,Surgical Outcomes And Quality Improvement Center,Chicago, ILLINOIS, USA 2University Of Kentucky,Center For Health Services Research,Lexington, KENTUCKY, USA 3Northwestern University,Hospital Medicine,Chicago, IL, USA
Introduction: The Illinois Surgical Quality Improvement Collaborative (ISQIC) was developed to improve the quality of surgical care across the state. Our objectives were to (1) assess the needs, barriers and resource gaps to quality improvement in Illinois, (2) develop and implement novel approaches to facilitate Quality and Process Improvement (QI/PI), and (3) develop an extensive evaluation plan to examine the effectiveness of program implementation.
Methods: Fifty-three hospitals in Illinois were surveyed about their QI/PI needs and resources (Resource Survey), Board/leadership involvement in QI, safety culture (Safety Attitudes Questionnaire-SAQ), and the baseline knowledge of QI among individual clinicians and QI personnel (Quality Improvement- Knowledge Assessment Tool-QIKAT). In addition, hospital site visits were conducted for in-depth qualitative assessments of QI resources and barriers. A combination of novel and evidence-based approaches were developed and implemented across all 53 ISQIC hospitals. A mixed-methods approach was created to triangulate data from surveys, ethnographic observations, semi-structured interviews, focus groups, artifact analyses and process mapping to measure the effectiveness of each newly implemented approach to QI.
Results:From the Resource Survey, hospitals commonly listed issues with insufficient financial resources, implementation of QI projects, communication and buy-in from leadership, and engagement among physicians. Hospital site visits revealed that surgeons were unsure how to lead QI programs or act upon data, whereas hospital administrators were concerned about startup costs associated with QI programs. Approximately 85% of respondents (n=950) for the SAQ rated their hospital favorably for teamwork and safety climate, but reported less favorably for perceptions of management and employee engagement. The average baseline test score (n=150) for knowledge of QI approaches from the QI-KAT was 65%. To address the QI/PI needs, 21 novel approaches, grouped into 5 domains: guided implementation, education, comparative reports, networking, and funding, were implemented at each hospital (Table 1). Continuous evaluation using the tools developed to measure the effectiveness of each of the 21 individual approaches have allowed for iterative modification and improvement of approaches.
Conclusion:By evaluating hospitals’ needs, barriers, resources, and baseline QI/PI knowledge, we were able to design 21 approaches to facilitate rapid and effective QI in Illinois. Continuous evaluation and iterative improvement of the 21 approaches has allowed us to tailor these initiatives to local differences at individual hospitals.
