title: Using Surgeon-Specific Outcome Reports and Positive Deviance for Continuous Quality Improvement.
abstract: BACKGROUND
  Using the thoracic morbidity and mortality classification to document all postoperative adverse events between October 2012 and February 2014, we created surgeon-specific outcome reports (SSORs) to promote self-assessment and to implement a divisional continuous quality improvement (CQI) program, on the construct of positive deviance, to improve individual surgeon's clinical performance.
  
  
  METHODS
  Mixed-methods study within a division of six thoracic surgeons, involving (1) development of real-time, Web-based, risk-adjusted SSORs; (2) implementation of CQI seminars (n = 6; September 2013 to June 2014) for evaluation of results, collegial discussion on quality improvement based on identification of positive outliers, and selection of quality indicators for future discussion; and (3) in-person interviews to identify facilitators and barriers to using SSORs and CQI. Interview transcripts were analyzed using thematic analysis.
  
  
  RESULTS
  Interviews revealed enthusiastic support for SSORs as a means to improve patient care through awareness of personal outcomes with blinded divisional comparison for similar operations and diseases, and apply the learning objectives to continuous professional development and maintenance of certification. Perceived limitations of SSORs included difficulty measuring surgeon expertise, limited understanding of risk adjustment, resistance to change, and belief that knowledge of sensitive data could lead to punitive actions. All surgeons believed CQI seminars led to collegial discussions, whereas perceived limitations included quorum participation and failing to circle back on actionable items.
  
  
  CONCLUSIONS
  Real-time performance feedback using SSORs can motivate surgeons to improve their practice, and CQI seminars offer the opportunity to review and interpret results and address issues in a supportive environment. Whether SSORs and CQI can lead to improvements in rates of postoperative adverse events is a matter of ongoing research.
authors.affiliation: Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address: jivanovic@toh.on.ca.
authors.forename: Jelena
authors.initials: J
authors.lastname: Ivanovic
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Anstee
authors.affiliation: Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Tim
authors.initials: T
authors.lastname: Ramsay
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gilbert
authors.affiliation: Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Donna E
authors.initials: DE
authors.lastname: Maziak
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Farid M
authors.initials: FM
authors.lastname: Shamji
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: R Sudhir
authors.initials: RS
authors.lastname: Sundaresan
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: P James
authors.initials: PJ
authors.lastname: Villeneuve
authors.affiliation: Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Andrew J E
authors.initials: AJ
authors.lastname: Seely
mesh_terms: D002983:Clinical Competence; D006801:Humans; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement / Q000458:organization & administration*; D020379:Risk Adjustment; D013903:Thoracic Surgery; D019616:Thoracic Surgical Procedures / Q000009:adverse effects; D017749:Total Quality Management / Q000458:organization & administration*