2052 Implementing a Quality Improvement Culture in Neurologic Surgery

INTRODUCTION: Quality Improvement (QI) initiatives have improved patient outcomes and streamlined hospital processes, so the Accreditation Council for Graduate Medical Education requires residents to participate in QI. However, neurosurgeons and residents at our institution reported barriers to commencing QI projects. METHODS: A multidisciplinary team with representatives from all stakeholder groups conducted the project at the Mayo Clinic from Oct 2019-Jan 2024 following Define-Measure-Analyze-Improve-Control QI methodology, Awareness-Desire-Knowledge-Ability-Reinforcement change management framework, and Standards for QI Reporting Excellence guidelines. This initiative did not require institutional review board approval. RESULTS: The team used a charter and a Suppliers-Inputs-Processes-Outputs-Customers+Requirements tool to diagram the baseline process. Electronic databases quantified baseline metrics. An Ishikawa diagram categorized gaps in quality and Failure Modes and Effects Analysis determined that the primary barriers were suboptimal education and mentorship. The team brainstormed solutions during a Kaizen burst and evaluated proposals via an Impact/Effort grid. To improve education, residents attended a day-long QI fundamentals course and passed an examination. The team conducted three Plan-Design-Study-Act cycles to optimize mentorship. The percentage of residents who completed a project increased from 9% to 87%. Twenty-one residents, 11 neurosurgeons, 14 nurses, 9 staff, and 7 APPs participated on projects. Eleven QI projects commenced, nine were completed, eight resulted in practice changes, and two are ongoing. Interventions included a cart to streamline procedures, a reorganization of personnel to increase efficiency, protocols, and electronic medical record tools. Rigorous stakeholder analysis and sequential completion of QI phases was associated with achievement of initial aims and sustained initiatives over time. CONCLUSIONS: Using QI and change management frameworks, a team developed a novel program comprised of education and mentorship for residents to complete QI projects. We recommend that residents receive formal training and coaching from experienced mentors.