Needs/Resource Assessment: Surgical Site Infections

Alignment

When you embark on any quality improvement project at your institution, the goals of your project must align with the institution's overall QI objectives. Sponsorship by an executive leader will facilitate your garnering of resources to complete and sustain the program. Once you have institutional support, developed aims, and stakeholder approval, the next step will be to define the operational needs for the project.

If you are working under the sponsorship of an executive leader, you must be very clear at the onset of you project about the amount of support you will need to complete and sustain your endeavor. Furthermore, it is critical to establish the metrics for success (i.e., the percentage improvement, rate of SSIs, MD or patient satisfaction, etc.). Consideration should be given to the following issues before starting a project.

1. Basic operations budget
   1. Data management
      Allocate time for data abstraction and management.
   2. Statistical analysis
      Consultation with a biostatistician will allow you to pick, track, and report the appropriate metrics but will require financial support.
   3. Information technology support
      Building reports and tools in an electronic record system will ideally minimize costs and enhance data management but will require resources to build up front.
   4. Paper/printing
      In a paper system, define who will pay for the printing costs of order sets, flow sheets, patient information documents, etc. . . . They will add up over time
   5. Meetings
      Will you feed your team? Who will pay for lunch?
   6. Clinical FTEs
      Will your project require new clinical FTEs (i.e., NPPs, clinical nurse specialists, therapists, pharmacists, physicians)?
2. Incentives and gain sharing
   1. Is there an incentive for your team to achieve the objectives of the project?
      Examples:
      Hospital-acquired condition — extremes in glycemic control— Will the work of your group help to achieve  local compliance with this present on admission POA measures? Will the pathways you develop for SSIs dovetail with other local efforts to improve diabetic care?
      Readmission rates— Will the processes your team implements help to lower the readmission rates to your institution? Can the processes be generalized across the institution?
   2. Align gains made by your team to be the incentive package for your group. Allow the success of your project to be tied to the institutional support your group may already be negotiating. Gain sharing can be an effective method for achieving quality goals while recognizing clinicians' involvement in the process. Local executives should always adhere to federal regulations around gain sharing and should consult with the state's QIO before a gain-sharing arrangement is undertaken.
3. Clinical "carve out"
   1. Will you and the clinicians involved in your project be remunerated for their effort, either by direct payment or by adjusting their clinical responsibilities to accommodate for the time devoted to the team?
   2. Have the clinical leads signed off on the proposal for their employees to work on your team?
   3. What is a reasonable remuneration, and is there a local precedent?
4. Durability
   1. Banced team. Is any 1 member of your team so essential to the success of the project that her or his absence would lead to the project's failure? How easily can team members be recruited or replaced?
   2. Perpetuity. Educate staff and providers such that processes and standards self-perpetuate. Seek feedback from end users regularly. Promote a culture of excellence in order to sustain your gains.
5. Sustainability of the project
6. Expansion to other departments
   1. account for growth. As the project gains steam, will your group be able to manage the volume?