Why Orthopedic Surgeons Should Be Very Cautious with Quality Improvement Without Proper Instruments; Quality Systems Are Not Your Enemy!

Every orthopedic surgeon most likely is convinced that her or his present working methods and procedures are performed in the best possible manner. You should be because you are the first to know and the first to blame when things go wrong. Patient feedback in case of serious adverse events can be very intense and confronting. So, you are highly motivated to deliver the best quality. All are familiar with quality initiatives to achieve high standards of care. Patients and society expect delivering outstanding quality of the medical service provided and delivered at acceptable costs. There are however opportunities or incitements to further improve the quality of your work. This could be innovations such as the introduction of robotic surgery or the introduction of new surgical technique in your department. Or even new facilities in your hospital that require adaptations in your way of working. Perhaps you are confronted with outcomes that urge you to reconsider your current methods. Last and probably not least, there is management that adopted fancy quality improvement methods that are introduced with the promise it could save a lot of money. Whatever the reason, every improvement could have an adverse effect. The change process in itself can cause a, hopefully temporary, loss of quality. The team has to learn and to adapt which can cause harm to the patient. Furthermore, after the introduction the proposed improvement could appear to be inherently less effective. This happened to the Boeing 737 Max, in which lethal design flaws reveled only after the introduction. So especially in healthcare sufficient caution has to be exercised while considering improvements and innovations. On the other hand, the modern surgeon doesn’t want to freeze in our hyper-innovative world. In addition, we are all morally obliged to improve the effectiveness and efficiency of our work to escape the squeeze between growing patient demands and diminishing financial means. Finally, deep inside we want to be the best, no matter what league you are playing in. Innovation and quality improvement therefore are inevitable in orthopedic surgery, but it has to be done with the highest possible caution. Quality systems can be of tremendous help. They are not your enemy. But make sure you understand them, and take some time to convert them into a tailor-made suit. In this chapter, we go through a number of quality improvement methods, systems, and tools primarily from industry but with ample application in healthcare. From our own experiences, we try to boil down to the essence and provide guidelines to healthcare workers on their improvement journey.