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Invited Commentary
March 2015

The Challenge of Quality Improvement in Surgical Care

Author Affiliations
  • 1Department of Surgery, University Health Network, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  • 2Department of Surgery and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
JAMA Surg. 2015;150(3):215. doi:10.1001/jamasurg.2014.2908

The story of surgical quality improvement has become a saga of high hopes followed by dashed expectations. Eminently sensible quality and safety interventions—promoted by opinion leaders, endorsed by health quality organizations, and supported by impressive results in promising early studies—too frequently fail to perform as expected when they are introduced into routine care. Reames and colleagues1 appear to have added one more disappointment to this boulevard of broken dreams. Keystone Surgery—a checklist-based quality improvement program modeled after the successful Keystone ICU (intensive care unit) program,2,3 consisting of a tool to enhance compliance with the Surgical Care Improvement Program process of care measures and a Comprehensive Unit-based Safety Program intended to improve teamwork and a culture of safety—did not improve the rates of adverse surgical outcomes as hoped when it was implemented in Michigan hospitals.

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