Quality Improvement Study [Neurosurgery Wiki]

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====== Quality Improvement Study ======

===== Title =====
**"Project Title"** – A Quality Improvement Initiative in [[Department/Hospital Name]]

===== Problem Identification =====
  * **Observed issue:** (Describe the current problem or deficiency.)
  * **Impact:** (Who or what is affected? How often? How seriously?)
  * **Baseline data (if available):** (e.g., infection rate, wait time, satisfaction score)

===== Background =====
  * **Known evidence:** (What is already known about this issue from literature or internal data?)
  * **Context:** (Brief description of your department or hospital and its relevance to the problem.)

===== Aim Statement =====
  * **Objective:** (What do you want to improve? How much? By when?)
  * Example: "Reduce ICU admission delays by 30% within 3 months."

===== Methods =====
==== Design ====
  * Describe the approach (e.g., PDSA cycles, pre/post intervention, Lean).
==== Intervention ====
  * What was implemented? How? By whom?
==== Measures ====
  * **Process Measures:** (e.g., compliance rate, number of checklists completed)
  * **Outcome Measures:** (e.g., patient mortality, satisfaction scores)
  * **Balancing Measures:** (e.g., unintended consequences)

===== Results =====
  * **Before and after comparison:** Include tables, figures or summary data.
  * **Successes:** (What improved? How much?)
  * **Unexpected findings:** (Positive or negative)

===== Discussion =====
  * **Interpretation:** (What do the results mean?)
  * **Barriers and enablers:** (What helped or hindered implementation?)
  * **Limitations:** (Design, data, generalizability)

===== Conclusion and Next Steps =====
  * Summary of impact
  * Sustainability plan
  * Recommendations for replication or scale-up

===== Appendices (optional) =====
  * Charts, protocols, team roles, PDSA documentation, etc.

====== Quality Improvement Study: Improving Team Motivation in the Neurosurgery Department ======

===== Problem Identification =====
  * **Observed issue:** There is a shared perception among staff that the neurosurgery team is demotivated, with decreased engagement, lower morale, and reduced participation in teaching, research, or quality initiatives.
  * **Impact:** Potential risk to patient safety, loss of talent, decreased productivity, reduced innovation, and burnout among staff.
  * **Preliminary evidence:** Informal interviews and anecdotal observations suggest withdrawal from voluntary activities, increased absenteeism, and reluctance to engage in improvement projects.

===== Background =====
  * **Known evidence:** Studies have shown that healthcare [[team motivation]] strongly correlates with [[leadership style]], [[recognition]], [[workload balance]], and [[communication culture]]. (E.g., Shanafelt et al., 2017; West et al., 2016)
  * **Context:** The neurosurgery department is a high-pressure environment with demanding clinical load, uneven distribution of academic responsibilities, and limited formal feedback mechanisms.

===== Aim Statement =====
  * **Objective:** To identify key factors contributing to team demotivation in the neurosurgery service and implement targeted interventions to improve morale and engagement by 30% within 6 months.

===== Methods =====
==== Design ====
  * Mixed-methods approach using pre/post intervention comparison.
  * Three stages: baseline assessment, intervention design, outcome evaluation.

==== Intervention ====
  * **Stage 1 (Assessment):**
    - Anonymous survey measuring motivation (Likert scale), workload perception, and satisfaction.
    - Optional focus groups for qualitative input.
  * **Stage 2 (Implementation):**
    - Regular feedback meetings.
    - Recognition of individual and team efforts.
    - Redistribution of academic and clinical tasks based on interest.
    - Monthly "open forum" with leadership.
  * **Stage 3 (Evaluation):**
    - Repeat survey after 6 months.
    - Measure engagement in optional activities (teaching, research, QI).
    - Track absenteeism and retention rates.

==== Measures ====
  * **Primary Outcome:** Change in motivation score (quantitative survey).
  * **Secondary Outcomes:** Participation rates, number of internal projects launched, feedback satisfaction.
  * **Balancing Measures:** Risk of overburdening active staff, perception of favoritism, meeting fatigue.

===== Results =====
  * **Before and after comparison:** To be completed post-intervention.
  * Include baseline statistics, visual representation of survey results.
  * Qualitative themes from open comments.

===== Discussion =====
  * **Interpretation:** Did the intervention address the root causes? What improved?
  * **Barriers:** Time constraints, skepticism, lack of protected time.
  * **Facilitators:** Leadership support, visible change, peer motivation.
  * **Limitations:** Single-department focus, short follow-up, subjective measures.

===== Conclusion and Next Steps =====
  * Summary: Initial results suggest that structured communication, transparency, and shared ownership can improve motivation.
  * Recommendation to expand initiative hospital-wide or to other departments.
  * Plan for sustainability: quarterly check-ins, inclusion of motivational metrics in performance review.

===== Appendices =====
  * Survey instrument
  * Focus group guide
  * Sample feedback report template
  * References: Shanafelt TD et al. Mayo Clin Proc. 2017; West CP et al. JAMA. 2016.

===== Anonymous Motivation Survey: Neurosurgery Department =====

Please answer the following questions honestly. Responses are anonymous and will be used solely to improve our team's working environment.

=== Motivation and Engagement ===
  * I feel motivated to come to work each day. (1–5)
  * I feel recognized for the work I do. (1–5)
  * I am proud to be part of this department. (1–5)
  * I feel emotionally exhausted or burned out. (1–5)
  * I feel encouraged to participate in academic or improvement initiatives. (1–5)

=== Workload and Support ===
  * My workload is fair and manageable. (1–5)
  * I have the resources and support I need to do my job well. (1–5)
  * I can speak openly with leadership about my concerns. (1–5)
  * Leadership values the input of all team members. (1–5)

=== Open-ended questions ===
  * What motivates you most in your work here?
  * What discourages you or causes frustration?
  * What could leadership do to improve the work climate?