title: Quality assessment in surgical care departments: proposal for a scoring system in terms of structure and process.
abstract: OBJECTIVE
  To build a score able to reflect and rank surgical departments according to a definition of "quality" in terms of structure and process.
  
  
  METHODS
  Collaborative design of a quality score in the framework of the French clinical research project NosoQual. Feasibility and observational study in 46 surgical departments visited between November 2002 and March 2003 according to standardised procedures. A bibliographic review followed by expert consultations, a field test, analysis and a final reconsideration leading to the definition of a consensual score.
  
  
  RESULTS
  138 variables comprised the score. They were classified into seven dimensions, each representing a different aspect of quality of care in surgery. According to the threshold and weight attributed to every variable, scores were calculated for each department. The average level of achievement of the scores varied from 42% to 71% of theoretical maxima. The variability of the scores related to the seven dimensions was larger and more significant than the one expressed by the overall score (coefficient of variation=0.1).
  
  
  CONCLUSIONS
  This analytical work contributed to the design of a quality score for surgery. However, the progress of the score should continue to take into account all the obstacles that were observed and to meet the high requirements of the actual patient safety issue.
authors.affiliation: Laboratoire d'Epidémiologie et Santé Publique, Université de Lyon, 8 avenue Rockefeller F-69373 Lyon Cedex 08, France.
authors.forename: J
authors.initials: J
authors.lastname: Najjar-Pellet
authors.forename: P
authors.initials: P
authors.lastname: Jambou
authors.forename: O
authors.initials: O
authors.lastname: Jonquet
authors.forename: J
authors.initials: J
authors.lastname: Fabry
mesh_terms: D006801:Humans; D007407:Interviews as Topic; D017146:Models, Organizational; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D013503:Surgery Department, Hospital / Q000145:classification / Q000458:organization & administration / Q000592:standards*