Defining, measuring, and improving surgical quality: Beyond teamwork and checklists to systems redesign and transformation

Background: Surgical complications are multifactorial but often are attributable to deficiencies in the quality of care. This review examines how quality is defined in surgery, the modalities employed to measure quality, and the approaches to improving the quality of surgical care. Beyond developing a hospital environment supportive of organizational learning, the next generation of surgical performance improvement will include broader, more innovative approaches. These ideas will create partnerships among patients, clinicians, industry, the arts, hospital leaders, and other sectors to look for ways to reinvent the system rather than simply to make a better hospital. Methods: Review of pertinent English-language literature on surgical quality, definitions of quality, quality measures, performance improvement, and organizational learning in health care. Results: Medical care should be safe, effective, patient-centered, timely, efficient, and equitable, as defined by the Institute of Medicine core values for health care quality. There is substantive lack of agreement as to how to measure the quality of care. Although the goal of each measurement system is to give patients the ability to compare hospitals nationally, most of the methodologies measure widely different aspects of hospital care, resulting in conflicting illustrations of institutional performance and confounded decision making for patients and for purchasers of healthcare services and insurance. Conclusions: The best pathway for surgical quality and performance improvement includes the application of systems engineering and innovation to determine ways to do better what we do currently, and to improve the present system while developing ideas for better delivery of high-quality care in the future.