A Qualitative Assessment of a Provincial Quality Improvement Strategy for Pancreatic Cancer Surgery
A study released in Ontario, Canada (1999) found a positive relationship between surgical volume and patient outcomes after pancreatic resection for cancer. In response, a province-level quality improvement (QI) strategy was initiated, which included the development and dissemination of a standards document and an audit and feedback exercise with surgeons. We assessed perceptions and actions of Ontario surgeons to this QI strategy.
We conducted semistructured interviews with surgeons and chiefs of surgery at three types of hospitals providing pancreatic cancer surgery, including hospitals that provided high volumes of surgery after 2001, hospitals that provided low volumes of surgery after 2001, and hospitals that provided low volumes of surgery before 2001 and stopped after year 2001. High-volume hospitals performed ten or more surgeries annually. The interview guide was based on Pathman’s model of physician practice change (i.e., awareness, agreement, adoption, and adherence). Grounded theory guided data collection and analysis.
Twenty-four interviews were completed. All groups were aware of the 1999 province-level QI strategy and agreed in principle with the standards document recommendations. Many surgeons had concerns regarding the number of cases necessary to be considered high-volume. Decisions to cease pancreas cancer surgery were occurring before 1999 and made at the surgeon level, often with input from the chief of surgery, but rarely with input from hospital administration.
Surgeons were aware of and agreed in principle with the province-level QI strategy for pancreas cancer surgery. Decisions to continue or cease performing surgery were made by individual surgeons.
KeywordsPancreas Cancer Standard Document Semistructured Interview Quality Improvement Strategy Hospital Administrative Data
Funding for this project was provided by the Canadian Cancer Society
- 4.Simunovic M, Urbach D, Major D, et al. Assessing the volume outcome hypothesis: a natural experiment involving pancreas cancer surgery in two Canadian provinces. Ann Surg Oncol. (in press).Google Scholar
- 6.Hutchison SA. Grounded theory: the method. In: Munhall PL, Oiler C, editors. Nursing research: a qualitative perspective. Norwalk, CT: Appleton-Century-Crofts; 1986. p. 111–30.Google Scholar
- 8.Auerbach CF, Silverstein LB. Qualitative data: an introduction to coding and analysis. New York: New York University Press; 2003.Google Scholar
- 12.Stitzenberg KB, Sheldon GF. Progressive specialization within general surgery: adding to the complexity of workforce planning. JACS. 2005;201(6):925–32.Google Scholar
- 14.Berwick DM, Godfrey AB, Roessner J. 10 key lessons for quality improvement. In: Berwick DM, Godfrey AB, Roessner J, (eds) Curing health care: new strategies for quality improvement. San Francisco: Jossey-Bass; 2002. p. 144–58.Google Scholar
- 16.Jamtvedt G, Young JM, Kristoffersen DT, et al. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. doi: 10/1002/14651858. CD000259.pub2 [Online June 21, 2009].