• Tejen A Shah, Xane D Peters, Shelbie D Waddle, Eileen Reilly, Sarah F Valek, Lynn Modla, Karen Pollitt, and Clifford Y Ko.
• American College of Surgeons, Division of Research and Optimal Patient Care, Chicago, IL.
• J. Am. Coll. Surg. 2024 Oct 16.

BackgroundStructured preparation is necessary to conduct quality improvement (QI) strategies that are relevant to the problem, feasible, appropriately resourced, and potentially effective. Recent work suggests improvement efforts are sub-optimally conducted. Our goal was to determine how well preparation for surgical QI is undertaken, including detailing the problem, setting project goals, and planning an intervention.Study DesignThis retrospective cross-sectional study included QI efforts submitted in 2019 to the American College of Surgeons (ACS) during review for accreditation across five ACS Quality Programs: Children's Surgery Verification (CSV), the Commission on Cancer (CoC), the Metabolic and Bariatric Surgical Accreditation and Quality Improvement Program (MBSAQIP), the National Accreditation Program for Breast Centers (NAPBC), and the Trauma Verification Program. Projects were scored for alignment with three components of the pre-conduct phase of the ACS Quality Framework: problem detailing, goal specification, and strategic planning.Results242 projects satisfied inclusion criteria and were scored. Most projects in the final cohort were from MBSAQIP (36%), CoC (31%), or NAPBC (29%) programs. The average overall pre-conduct score was 52% (Standard Deviation (SD)=17). On average, projects performed best in the 'Goal Specification' component (65% SD=27), followed by 'Problem Detailing' (52% SD=16), and 'Strategic Planning' (44% SD=25). Within these components, identification of possible limitations (5%) and consideration of contextual issues (12%) were among the least frequently reported items.ConclusionsThorough planning is a critical component of effective QI, and our study reflects significant opportunity for its improvement. The ACS Quality Framework may serve as a guide to improve QI planning, thereby promoting efficiency and effectiveness of these efforts.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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