A continuous quality improvement project

Hospital Authority (HA), a statutory body responsible for managing public healthcare in Hong Kong, provides 90% of inpatient hospital services. The Surgical Outcomes Monitoring and Improvement Program was launched to monitor and improve the surgical outcomes of patients managed under HA. Tuen Mun Hospital, the largest acute hospital in Hong Kong, was committed to implement quality improvement projects to improve patients' outcomes after reviewing the first report in 2010. Other than the possibility of surgical technique failure, there were multiple cultural and managerial problems recognised, which could have contributed to the suboptimal outcome. The Surgical Quality and Safety Circle was formed, and was composed of hospital administrators and consultants from departments of surgery, anaesthesia and intensive care, and aimed to create a patient-centered culture. It also aimed to improve the fundamental standards of services provided, promote inter-departmental co-ordination and communication, ensure continuous medical education, and discuss policies and strategies regarding patient service management. Members attended meetings every four-to-six weeks, in which complicated cases were discussed. The four main areas focused on during case discussion were: interdisciplinary communication; logistics, workflow and policy making; continuous professional education; and improving communication between hospital management and clinicians. As a strategy for change, the ‘Speak up culture’, which was under-developed in the locality, was promoted. 400 comments and suggestions had been arrived at during group discussion across 25 meetings since February 2011. There were more than 10 inter-departmental and hospital based improvement programmes successfully implemented based on the clinical and system weakness identified in the meetings.