I prepared these slides while working on CoP in cancer surgery in 2007

1. Literature Review Results 2007 Sustainable Collaborative QI Projects in Surgery

2. ‘ COMMUNITIES OF PRACTICE’ AS MEANS OF QUALITY IMPROVEMENT IN SURGERY: A SYSTEMATIC REVIEW Facilitators/Administrative support for projects IT/Decision Support Communication system CME and CPD programs Guidelines/care protocols Lack of skills and tools to implement improvement projects Support Resources Leadership of: National Institutions (IHI, NHS) Peer Review Organizations Individual Hospitals Opinion Leaders Surgical Networks Shared administration/clinical leadership Administrative/nursing resistance to the clinician-lead innovations Clinicians’ suspicions for administrative top down interventions Leadership (institution vs. surgeon lead) Reliance on study grants and collaboration with the state peer review organizations (PRO)/agencies accountable for Quality Improvement Institutional barriers; for instance Hospitals do not financially support clinicians innovations Sponsorship/funding Solutions Barriers Key Elements

3. ‘ COMMUNITIES OF PRACTICE’ AS MEANS OF QUALITY IMPROVEMENT IN SURGERY: A SYSTEMATIC REVIEW Solutions Barriers Key Elements Benchmarking PDSA Structured Dialogue/Appreciative Inquiry Use of Physicians Opinion Leaders Multidisciplinary teams Pathways Confidential peer review/audits Lack of training in QI methodology Lack of a firmly established evidence on optimal interventions and implementation strategies Methodology Ownership of projects (NNE, STS) Institutionalization of innovative approaches (voluntary databases became integrated in hospitals operations, peer audit becomes part of the accreditation process) Over-polarization Change in leadership Difficulties with maintaining levels of engagement Sustainability Open membership to all allied specialists (cardiac projects, NHS) Defined/limited/specified membership ( IHI BTS training for the selected teams sponsored by hospitals, identification of champions and multidisciplinary teams) Politics of various departments and clinical units Communication breaks between disciplines Membership

4. ‘ COMMUNITIES OF PRACTICE’ AS MEANS OF QUALITY IMPROVEMENT IN SURGERY: A SYSTEMATIC REVIEW Patriot Hospital Individual Hospital California (Kaiser Permanente), Connecticut, Northern London Cancer Network Regional registry (Michigan, Washington, Alabama, NY, NNE, Pennsylvania, California, Austin- Australia) Regional Defined process improvement targets (UK – wait times, US IHI – SSI) STS database –defined outcome targets National Administration Leads Physician Leads

10. Administration-lead: Kaiser Permanente Operation Innovation The timely diagnosis of Breast cancer (increase from 32% to 79% of patients diagnosed within 14 days from first suspicion to post-biopsy surgery consult) Collaboration between pathology/ radiology/surgery : Pathology: reporting within 48 h Radiology: returning patients for biopsy within 2-3 days Surgery: direct booking the post-biopsy patients by DI/Radiology