Rethinking Operating Theater Quality: From Indicators to Dimensions

We read with great interest the recent article by Tewari et al., titled “A Study of the Quality Indicators in Operation Theater at a Tertiary Care Hospital in Durgapur.”[1] This study conducted a prospective analysis of quality indicators derived from 2953 surgical procedures. The indicators systematically collected and examined included key metrics such as operation theater utilization rate, rescheduling of surgeries, unplanned returns to the operation theater, and adverse events due to anesthesia. The findings establish a robust foundation for the continuous enhancement of operation theater quality and safety, as well as for strengthening the quality monitoring system. However, further developing the measurement model from isolated indicators to dimensional associations could provide more evidence-based decision support for precision quality control in the operation theater. Measurement serves as the foundation for assessing potential improvements in healthcare quality.[2] Healthcare quality measurement encompasses four core dimensions of volume, structure, outcome, and process, with each dimension composed of specific corresponding indicators.[2] Research has demonstrated that the dimensions of healthcare quality are intrinsically related, with structure, process, and outcome being mutually interdependent.[3,4] In particular, structure often shapes outcome indirectly via process, suggesting that process functions as a mediating variable in the mechanism of quality formation. In this study, the authors applied the STEEEP framework, which encompasses the six domains of healthcare quality, and selected eight operation theater quality indicators for measurement and evaluation. Subsequently, they employed descriptive analysis to present each indicator’s performance against benchmarks and identify areas requiring improvement. However, this analytical approach may be limited in uncovering the underlying causal relationships and interaction mechanisms among the indicators or across the six domains, as these dimensions and indicators are unlikely to be independent of one another. Therefore, we recommend that future research introduce structural equation modeling to further develop the measurement model. Building on descriptive analysis, this approach could explore causal pathways among the various dimensions and indicators.[5] Specifically, the eight operation theater quality indicators could be categorized into exogenous and endogenous latent variables. Following this step, model fitting would enable quantification of the direct and indirect path coefficients, thereby revealing the underlying mechanisms through which quality dimensions interact. Overall, this methodological approach is expected to provide more explanatory and evidence-based scientific support for quality control in the operation theater. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.