In the fast-evolving landscape of surgical quality improvement (QI), the success of initiatives hinges largely on the adequacy of their initial planning phases. Recent empirical evidence has unveiled a significant shortfall in the preparatory stages of small-scale surgical QI projects, where over 98% of efforts failed to meet essential planning benchmarks. Recognizing this glaring deficiency, a pioneering research team has developed and validated an innovative framework specifically designed to elevate the rigour and comprehensiveness of early-stage QI project planning in surgical settings. This breakthrough has the potential to redefine quality enhancement practices across medical institutions globally.
The genesis of this advancement can be traced to a systematic evaluation encompassing fifty distinct surgical QI initiatives. Shockingly, only a single project surpassed the threshold of 70% compliance with established criteria indicative of robust planning and execution. Subsequent in-depth analyses of a further 242 projects reinforced the conclusion that the so-called “front-end” of planning remains the most critical, yet underperforming, element in achieving success. Such deficits in groundwork are not trivial; they compromise the entire project trajectory, often culminating in diminished patient outcomes and resource wastage.
Responding to this unmet need, researchers introduced the Early Planning of Small-Scale Surgical Improvement (EPoSSI) framework — a meticulously structured, nine-step roadmap tailored to guide clinical teams through the multifaceted challenges of project initiation. EPoSSI consolidates best practices distilled from an exhaustive review of nearly 400 existing QI frameworks, harmonizing them into an actionable guide. By systematizing the early planning process, EPoSSI eliminates common oversights and provides a clear pathway from conceptualization to implementation readiness.
A cornerstone of EPoSSI’s development was its rigorous, multi-phase methodology. It incorporated a modified Delphi process involving over 130 frontline clinicians and quality improvement specialists, ensuring the framework’s relevance and practicality within real-world surgical environments. This collaborative approach yielded an instrument that balances technical rigor with operational feasibility, empowering surgeons and their multidisciplinary teams to rigorously define goals, interventions, and monitoring mechanisms during the critical pre-launch phase.
Empirical testing of the EPoSSI tool demonstrated striking efficacy. When participants were asked to devise QI project plans without guidance, their proposals met only 24% of critical planning criteria on average. Conversely, employing the full EPoSSI suite — comprising a visual nine-step flowchart and a detailed guidance table — resulted in flawless adherence to all 26 evaluative measures. This leap from suboptimal to exemplary planning highlights the transformative potential of the framework to institutionalize best practices systematically.
Moreover, EPoSSI’s benefits transcended individual experience levels and team compositions. The framework proved equally effective for seasoned attending surgeons, surgical residents, and varied team dynamics, underscoring its versatility and broad applicability. The tool’s agnostic design allows integration with prevalent improvement methodologies—whether Lean, Six Sigma, or Model for Improvement—without necessitating paradigm shifts, thereby facilitating swift adoption.
The nine integral steps within EPoSSI articulate a comprehensive sequencing: assembling the multidisciplinary improvement team; precisely articulating the target problem; clearly delineating project aims; identifying feasible interventions; strategizing implementation logistics; designing in-project monitoring protocols; establishing criteria for end-of-project decisions; conducting a critical go/no-go evaluation; and planning the seamless transition to project delivery. This structured sequence ensures no crucial considerations are overlooked, fostering a culture of intentionality and accountability.
Drawing parallels from industries like construction, where meticulous front-end planning has empirically yielded delays reduced by 10-15% and cost savings averaging 20%, surgical QI can reap analogous benefits. Attention to early strategic decisions enables optimization of resources, minimizes project abandonment rates, and accelerates time-to-impact for patient care improvements. Dr. Clifford Y. Ko, the study’s lead author and Senior Vice President of the ACS Division of Research and Optimal Patient Care, emphasizes that EPoSSI equips frontline clinicians with a “low-burden” yet “systematic” framework, essential for navigating the complex terrain of healthcare innovation.
The broader implications of this research are profound. By standardizing the front-end processes of QI projects, EPoSSI addresses a heretofore underappreciated bottleneck that compromises surgical performance enhancement. Its adoption stands to catalyze a paradigm shift in how healthcare providers conceive and operationalize patient-centered improvements, aligning clinical ambitions with methodological rigor.
Importantly, EPoSSI’s development underscores the value of interdisciplinary and consensus-driven approaches in the formulation of tools that impact clinical practice. The engagement of a diverse pool of clinicians and improvement experts throughout its iterative refinement enhances the framework’s credibility and ensures that it resonates with the nuances of varied clinical contexts.
With the framework publicly accessible on the American College of Surgeons (ACS) platform, it is positioned for widespread dissemination among surgical communities. As healthcare systems increasingly prioritize value-based care and patient safety, integrating robust planning instruments like EPoSSI can serve as a cornerstone for sustainable QI initiatives, driving measurable enhancements in surgical outcomes.
In conclusion, the introduction of the EPoSSI framework represents a significant leap forward in ensuring that small-scale surgical quality improvement projects are grounded in meticulous and comprehensive planning. By mitigating the pervasive planning deficits identified across hundreds of prior initiatives, EPoSSI heralds an era where surgical teams can approach improvements with enhanced confidence, clarity, and efficacy. This advancement promises not only improved resource utilization but also, crucially, elevated standards of patient care and safety within surgical disciplines worldwide.
Subject of Research: Surgical quality improvement project planning and methodology
Article Title: Development and Testing of a Framework to Support the Planning of Small-scale Improvement Projects in Surgery: A Multi-Stage Process including a Modified Delphi Exercise
News Publication Date: 14-Oct-2025
Web References:
https://staging.facswebsites.com/quality-programs/qi-resources/epossi-tool/
https://journals.lww.com/journalacs/abstract/9900/development_and_testing_of_a_framework_to_support.1435.aspx
http://dx.doi.org/10.1097/XCS.000000000000165
References:
Ko CY, Giusti A, Martin G, Dixon-Woods M. Development and Testing of a Framework to Support the Planning of Small-scale Improvement Projects in Surgery: A Multi-Stage Process including a Modified Delphi Exercise. Journal of the American College of Surgeons. 2025. DOI: 10.1097/XCS.000000000000165.
Keywords:
Surgical Quality Improvement, Project Planning, Healthcare Improvement, EPoSSI Framework, Delphi Consensus, Patient Safety, Clinical Interventions, Quality Enhancement, Surgical Outcomes, Healthcare Methodology
