Forging a new Quality Improvement Network for upper GI surgeons.

Working in partnership with Imperial College the Quality Improvement Clinic co-designed and co-delivered a learning exchange for surgeons keen to improve the upper GI patient pathway. Krishna Moorthy, Senior Lecturer and Honorary Consultant Surgeon at Imperial College, invited participants partnering in this alliance to share their experience of practice and support each other in making improvements across the pathway (pre-operative, peri-operative, post-operative and follow-up). The starting point was to explore and make improvements to achieve a reduction of chest complications (by one third) and a reduction in leak rates (by half).

Patient representatives also participated, providing surgeons with first hand feedback on their experiences of the pathway. Together they highlighted areas for improvement and voted to indicate the strength of interest amongst the alliance members towards collective improvement efforts being made.

A key part of the learning was to identify and capture current variation in practice across the four segments of the pathway and between the centres represented (12 organisations). Ms Sophie Doran, Specialist Registrar for Mr Moorthy shared the results of her pre-meeting research regarding variations in the nature of and scope of protocols used. These ranged from 35 pages in one centre to one sheet of A4 from another, and many in between. Variation in specific procedures was also evident – and of a much smaller magnitude!

qulaity-improvement-networkNicola Davey from the Quality Improvement Clinic together with Susan Burnett from Imperial facilitated learning on measurement. Charles Vincent dropped into the measurement session and joined Krishna and over 20 surgeons and theatre staff, in a different kind of theatre.   Through the making and flying of paper planes they were able to explore the topic of variation and experience making practical changes that resulted in an improvement within the confines of the panelled venue!

Participants agreed on a working definition of chest complications and then discussed who would collect the data needed, what and when.

The outcomes of the learning exchange were powerful with the alliance committing to patient focused improvements, further collaboration to share data and the development of protocols for the follow-up stage of the pathway.