Designing and integrating a quality management program for patients undergoing head and neck resection with free-flap reconstruction

Abstract

Background: Care pathways (CPs) offer a proven method of systematically improving patient care. CPs are particularly helpful in complex clinical conditions where variation in care is a problem such as patients undergoing major head and neck resection with free flap reconstruction. Although CPs have been used to manage this patient group, most CPs are implemented as part of relatively short-term quality improvement projects. This paper outlines a detailed methodology for designing and delivering a quality management program sustained for 9 years. Methods: We describe a change management approach informed by Kotter's "8 Step Process" that provided a useful framework to guide program development and implementation. We then provide a detailed, step by step description of how such a program can be implemented as well as a detailed summary of time and costs for design, implementation and sustainability phases. An approach to design and delivery of a measurement, audit and feedback system is also provided. Results: We present a summary of resources needed to design and implement a head and neck surgery quality management program. The primary result of this study is a design for a sustainable quality management program that can be used to guide and improve care for patients undergoing major head and neck resection with free flap reconstruction. Conclusions: A change management approach to design and delivery of a head and neck quality management program is practical and feasible.

Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare

“…Leading change activities included having a sponsor or champion and team members who demonstrated visible, active, public commitment and were supportive of the change. Dort 36 2020 Quantitative Eight KPIs Academic Teaching Hospital, Canada Head and Neck surgery Department Kotter’s 8-Step Process Outline and describe a quality management program Demonstrated sustained high clinical performance when compared to a non-pathway managed cohort using 7 years of prospective outcomes data. Dredge 37 2017 Mixed Methods Working party and survey Calvary Health Care Bethlehem community palliative care service, NSW, Australia Nurses in an outpatient palliative care service Kotter’s 8-step To change anticipatory medicine practices in palliative care Study identified carers found it difficult to attend training however, found the step by step instructions useful to administer medicines in a timely manner without a nurse.…”

“…Step Model for managing change, with one further study that integrated the Kotter model with Silversin and Kornacki's model. [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] Eight studies referenced their application of the Lewin 3-Stage Model of Change into a healthcare setting, [48][49][50][51][52][53][54][55] with three further studies that integrated the Lewin model with a concern-based change management approach, McKinsey 7S Model of Change, and Roger's Diffusion of Innovation Theory, respectively. [56][57][58] A further eight articles reported the use of six further models for managing and leading change: Influencer Change Model (1 study); 59 Prosci ADKAR (1 study); 60 Accelerated Implementation Methodology (AIM) (2 studies); 61,62 Advent Health Clinical Transformation Model (1 study); 63 Riches 4 stage model (1 study); 64 Youngs Nine Stage Framework (1 study), 65 and the CAP model (1 study).…”

“…65 The Kotter model was also applied in a quality improvement program in head and neck surgery in a Canadian surgical department, with authors concluding the model provided a guiding principle to support the change process. 36 In a further leadership-focused change program, the Comprehensive Unit-Based Safety Program (CUSP) model within the Division of General Surgery applied the Kotter 8-step and five principles of dualoperating systems to the development and implementation of surgical quality improvement initiatives. 35 A guiding coalition of leaders that included staff and resident surgeons, nursing leaders, allied health and hospital administrators was brought together to tackle two key quality issues identified around surgical site infection (SSI) by front-line staff of wound care and poor team communication.…”

Efficacy of Multimodal Analgesia for Postoperative Pain Management in Head and Neck Cancer Patients

“…Two patient groups were compared. A pre-MMA cohort that included patients who underwent surgery between January 2015–December 2015 and were managed using the Calgary Head and Neck Enhanced Recovery Program (CHERP) protocol [ 4 , 17 , 18 ]. The MMA cohort included all patients who underwent surgery between December 2017–June 2019 and received the CHERP protocol plus additional ERAS elements including treatment with MMA.…”

Wearable activity trackers and mobilization after major head and neck cancer surgery: You can't improve what you don't measure

“…We have recently conducted a feasibility study 30,42 within the Calgary Head and Neck Enhanced Recovery Program 4,43 to add WATs to the postoperative period. A wrist-worn WAT (Garmin vívofit®4) was provided on POD 1 following major HNC surgery with free flap reconstruction.…”