title: The implementation of a surgeon-directed quality improvement strategy in breast cancer surgery.
abstract: BACKGROUND
  The investigators designed a sustained, surgeon-directed, iterative project to improve the quality of breast cancer surgery in south central Ontario.
  
  
  METHODS
  The strategy included audit and feedback of surgeon-selected quality indicators, workshops, and tailoring interviews. Workshops were held to discuss quality improvement strategies, select quality indicators, review audited results, and select interventions for subsequent implementation. Semistructured tailoring interviews were conducted to identify facilitators and barriers to improved quality. All presentations and results were disseminated to all surgeons performing breast surgery in the study region.
  
  
  RESULTS
  Forty-four surgeons performing breast surgery across 12 hospitals are involved in the project. Five workshops have been held since 2005. Surgeons' enthusiasm and involvement in the project have been positive. Interim results demonstrated that over 4 audit cycles (2006-2010), the preoperative core biopsy rate increased from 73% to 92%. The tailoring interviews indicated that 18 of 21 surgeons performed preoperative core biopsies.
  
  
  CONCLUSIONS
  This project highlights the feasibility of a surgeon-directed, iterative quality improvement strategy in breast cancer surgery. Interim results demonstrate consistent improvements in a key selected quality indicator.
authors: Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada. Electronic address: lovricsp@mcmaster.ca.
authors: Peter
authors: P
authors: Lovrics
authors: Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada; Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada.
authors: Nicole
authors: N
authors: Hodgson
authors: Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
authors: Mary Ann
authors: MA
authors: O'Brien
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON, Canada.
authors: Lehana
authors: L
authors: Thabane
authors: Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada.
authors: Sylvie
authors: S
authors: Cornacchi
authors: Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada.
authors: Angela
authors: A
authors: Coates
authors: Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada; Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada.
authors: Barbara
authors: B
authors: Heller
authors: Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada; Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada.
authors: Susan
authors: S
authors: Reid
authors: Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada; Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada.
authors: Kenneth
authors: K
authors: Sanders
authors: Department of Surgery, McMaster University and St Joseph's Healthcare, 50 Charlton Avenue East, G802, Hamilton, ON L8N 4A6, Canada; Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors: Marko
authors: M
authors: Simunovic
mesh_terms: D001291:Attitude of Health Personnel; D062005:Biopsy, Large-Core Needle / Q000592:standards / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000601:surgery*; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007430:Intraoperative Care / Q000193:education / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D008408:Mastectomy / Q000193:education / Q000379:methods / Q000592:standards*; D008485:Medical Audit; D008495:Medical Oncology / Q000193:education; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000193:education / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies
keywords: Audit and feedback; Breast cancer surgery; Continuing medical education; Core biopsy; Quality indicators; Tailoring