Surgical care improvement project

AORN Journal,  Jan, 2008  by Catherine Hackney

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I am an Australian perioperative nurse manager, and I was very interested to learn about the Surgical Care Improvement Project (SCIP) that is currently being undertaken in the United States ("Surgical Care Improvement Project and the Perioperative Nurse's Role," Vol 86, July 2007). The SCIP initiative aims to reduce surgical morbidity and mortality by standardizing practice and linking compliance with funding. Both of these measures have previously proven to be less than effective when introduced in isolation. Therefore, the goal of preventing 13,000 surgical deaths and decreasing complications by 271,000 per year seems hopeful rather than likely.

The recommended changes are not new. Evidence supporting these practices has been available for decades, but implementation has been inconsistent. Although standardizing practice is conceptually and potentially useful, "mistakes often occur in spite of the rules, procedures, protocols and guidelines that exist to prevent them." (1(p7))

Attempts to tie mandatory reporting of compliance to institutional reimbursement have fallen short of expectations elsewhere. Recent experience of the English National Health Service has shown that linking "target compliance" with remuneration has had unintended consequences, such as unexpected increases in nontargeted waiting lists and a decrease in compliance with nontargeted clinical indicators. This has led to managerial gaming, such as manipulation of data collection (eg, through diverting ambulances, reclassifying patients), to achieve targets rather than ensuring that improvements in service occur. (2) This also has been reflected in our experience in Australia, with the introduction of waiting list reduction targets for elective surgery being a notable example. Targets were achieved, but at some opportunity cost, and improvements in the quality of the service were less then predicted.

The SCIP initiative has the potential to be very effective. It requires a commitment to the integration of clinical governance and good leadership and management as well as appropriate resources and team functioning. (3) The challenge for perioperative nurse leaders is to ensure that the SCIP recommendations do not just become another box to tick.

REFERENCES

(1.) Courtney M, Klinken A, Majoor J, Ibrahim J, Day GE. Work design in health care. In: Harris MG, ed. Managing Health Services--Concepts and Practice. 2nd ed. Sydney, Australia: Elsevier Mosby; 2006.

(2.) Bevan G, Hood C. Have targets improved performance in the English NHS? BMJ. 2006;332(7538):419-422. http://www .bmj.com/cgi/content/full/332/7538/419. Accessed October 9, 2007.

(3.) Kohn LT, Corrigan J, Donaldson MS. Creating safety systems in health care organizations. In: To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999:134-174.

CATHERINE HACKNEY

RN, BN, GRAD DIP PERIOPERATIVE NURSING

PERIOPERATIVE SERVICES MANAGER

MATER MISERICORDIAE HOSPITAL MERCY HEALTH AND AGED CARE CENTRAL QUEENSLAND

BUNDABERG, QLD, AUSTRALIA

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