327(Fig. 19.1) in which an idea is generated (plan), a test of that idea is carried out
(do), the data are analyzed (study), and appropriate changes are made (act) [ 9 ].
Ideally this cycle repeats itself to generate continuous quality improvement. These
projects often result in real changes in process improvement that impact patient
care directly.
Surgical Simulation and Certification
Surgical simulation is an increasingly important aspect of surgical education in
the current era of increasing focus on outcomes and patient safety. Simulation
allows trainees to practice safely prior to entering the operating room. It is impor-
tant to note, however, that simulation should not replace real surgical training
opportunities but may be an important adjunct to surgical training. The focus of
many simulation programs has been on laparoscopic and endoscopic surgery
[ 19 ]. Open surgical simulation includes live animals, cadavers, bench models
(products from limbs and things, etc.), virtual reality simulators, and computer
simulators. These methods have poor data support and are often expensive to
initiate but may provide an important long-term adjunct to traditional operative
surgical training.
What are we trying to
accomplish?How will we know that a
change is an improvement?What change can we make that
will result in improvement?Act PlanStudy DoFig. 19.1 The plan-do-
study-act (PDSA) model
for continuous quality
improvement. After
identifying a problem and
understanding how
changes may result in
improvements, the PDSA
cycle may be used and
outcomes generate ideas
for new problems that may
benefit from further PDSA
cycles, hence continuous
quality improvement
(Permission requested for
use by publisher of
Langley et al. (2009))
19 Quality Improvement and Patient Safety