Healthcare Innovation Program
Reducing Surgical Mortality Rates
Surgical care is one of the most critical services in any healthcare system around the
world. Surgical care makes up a significant portion of all health care services offered,
representing 28–32 % of the global healthcare burden (Watter, Babidge, Kiermeier, McCulloch,
& Maddern, 2016). Quality issues that generally contribute to high mortality rates are;
inappropriate operations, errors in post-operative treatment and mismanagement of post-
operative complications (Chen et al., 2016). The Australian population is aging (McDonald,
2016). The quality improvement program aim is to reduction of surgical mortality rates. The
quality improvement project is set in a surgical ward, with a bed capacity of 30 patients, in large
200-bed capacity hospital.
Background
In Australia, the number of surgical admissions has been increasing. For example,
between the 2013 and 2014, the number of hospitalizations in need of surgical operations
increased by 2.3 %. The number of hospital admissions is accompanied by an increase in the
number of both emergency and elective surgical procedures. Owing to the high level of
complexity of surgical operation, some level of mortality rates is always anticipated (Chan,
Gupta, Babidge, Worthington, & Maddern, 2019).
SMART goal statement: To reduce the rates of surgical mortality among patients aged 65
years and above, in the surgical ward of the selected hospital. The aim of the healthcare quality
innovation program is to reduce the number of deaths associated with pre-operative and post-
operative management of patients prior and after surgical operation intervention.
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Program Description
One of the objectives of the healthcare innovative programs in reducing surgical
mortality is prevention of sepsis following surgery. Post-surgical patients are at risk of infection
to the site of infection (Chen et al., 2016). The hand-washing technique will be adhered to in the
ward. Inappropriate post-operative management is another common cause of surgical mortalities,
for instance, the failure to recognize and manage other postoperative infection complications.
One of the main causes of post-operative deaths is sepsis, among others such as, cardiac shock,
deep venous thrombosis, pulmonary embolism and intestinal bleeding. Chen, Retegan, Vinluan
and Beiles (2016) stated the clinical management issues of surgical cases in the world
significantly contribute to mortality rates. Lack of expertise and failure to appropriately start
antibiotic treatment is part of inappropriate post-operative management. Gupta et al. (2017)
found out that withheld or delayed antibiotic therapies lead to excessive bleeding and sepsis
receptively, which are potential causes of surgical deaths. Failure to use critical care facilities in
needed circumstances and inappropriate diagnosis are additional causes of surgical mortalities.
Additional practices will include adherence to the aseptic technique when performing
procedures on post-operative patients. Equipment, linen and instruments will be handled,
disinfected and disposed of appropriately (National Health and Medical Research Council
[NHMRC], 2017). The expected outcome of this intervention is to maintain a clean environment
which is free from organisms that may cause infections to postoperative patients. Compliance
with hand hygiene, protective wear and general infection prevention steps in an infection risk
setting will be carried out. Incidence reports and surveillance data about infection transmission in
the ward will be audited periodically.
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Comprehensive documentation is part of the initiative that will be used to improve the
care for post-operative surgical patients. Generally, in Australia, the Postoperative Surgical
Mortality Rate (POMR) has been declining. Chen et al. (2016) found out that POMR reduced by
about 15% between the year 2009 and 2013. However, there was an increase of POMR among
surgical patients aged above 80 years. Similarly, Beiles, Retegan and Maddern (2015) reported a
decrease of 20% in POMR in Victoria State and Western Australia. The POMR is not consistent
across Australia. The reported POMR varies across region and time in Australia. According to an
audit study done by Watters et al. (2016), the POMR reduction varied before and after 2013,
when the study was conducted. In the same study, the authors reported that marked improvement
has been only observed in Western Australia. Other states such as Queensland and Victoria have
recorded improved POMR although at a slower rate (Davis, Babidge, Kiermeier, Aitken
&Maddern, 2018).
Post-operative mortality is a key indicator that has been used conventionally to measure
the benefits versus harms before conducting surgeries. The evidence of reduced POMR implies
that an improvement of the existing quality initiatives will potentially lead to further decrease in
the rates of surgical mortality, among the elderly and other patient populations in any health care
setting in Australia (Kiermeier et al., 2017). The variations in the rates of reduction of surgical
mortalities warrant continuous data collection and reporting on POMR.
The current surgical mortality rates in Australia have been associated with various
factors. Misdiagnosis and inappropriate care contribute to surgical mortality. Healthcare workers,
such as nurses, contribute towards this trend at the pre-operative phase. For instance, patients
with history of head injuries presenting with clear neurological defects are delayed for
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investigations such as head computed tomography (Chen et al., 2016). Neurological symptoms
deteriorate rapidly despite the absence of imminent symptoms.
Documentation is both a safety and healthcare. Misdiagnosis is one of the main factors
leading to surgical mortalities in Australia (Pitcher, Lin, Thompson, Tayaran, & Chan, 2016).
Documentation, as an innovative program, ensures that the patients’ subjective data of symptoms
and complains are recorded as part of surgical care. Inaccurate documentation leads to errors in
treatment prescription during the pre-operative, intraoperative and posts operative stages of
surgical care (Mykkänen, Miettinen, & Saranto, 2016). Appropriate documentation record is
integral in surgical and any other from care to surgical patients.
Collaborative assessment approach will reduce the rate of surgical mortalities among the
patients. Surgical patients present with multiple or chronic conditions that require input from
different professionals. The excepted outcome from collaborative patient assessment is to
identify the factors that contribute to mortality rates among surgical patients. Collaborative
assessment of surgical patients forms the basis for interventions to reduce the mortality. The
assessment phase of patient care incorporates the tools used and the role played by other
clinicians (Eamer et al., 2018). The specific activities each of the patient’s assessment and
screening is considered as a unique case. Therefore, the model will guide leaders within the
clinical area to report to the different levels of competencies of the employees.
Continuous data collection on quality of care to surgical patients is critical. The data
collected will be comprehensive and accurate. Continuous monitoring of performance and
quality indicators will inform the outcome of quality improvement measures and deviation from
the expected outcomes. The data will form the basis for corrective actions and give feedback on
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quality surgical interventions that do not meet the expected standards (Davis, Babidge,
Kiermeier, Aitken, & Maddern, 2018).
The data on the indicators of risk management in the surgical clinical ward will be shared
with the clinical staff of hospital management. The expected outcome from quality and
performance monitoring is to identify trends in the adherence to quality and performance
guidelines.
One of the clinical practice guidelines is “The World Health Organization’s My 5
Moments for Hand Hygiene” guidelines that offer applicable, evidence based and easy to use
guidelines on when to wash hands (Moghnieh et al., 2017). Hand hygiene is one of the measures
to reduce post-operative sepsis. Australian guidelines of infection prevention guidelines form the
basis of the recommendations to reduce sepsis among post-operative patients (Hor et al., 2017).
Model of Leadership
The model emphasizes on the ability of a leader to adopt leadership tactics that are
appropriate in the prevailing circumstances, as opposed to individual’s inborn leadership traits.
The model assists leaders to deal with a specific working environment, goal oriented tasks and
different levels of employees’ competence. According to the model, leaders should satisfy the
employees, customers and other stakeholders (Zaccaro, Green, Dubrow, & Kolze, 2018). The
situational leadership model is appropriate for the implementation of the program that aims at
reducing the mortality rates among surgical patients in a given clinical setting. The clinical
setting is unique from any other setting in the healthcare system. Further, the program addresses
a particular health issue, that is, surgical mortalities. The clinical issue is distinct from other
clinical issues in the same setting. The situational leadership model will enable the leaders to
apply leadership tactics tailored towards reducing surgical mortalities in the surgical ward
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(Thompson & Glasø, 2015). The initiative program entails activities that are different from other
similar programs. The program addresses a specific healthcare issue in a given clinical setting.
Therefore, the readers are required to develop unique and new leadership skills to successfully
execute the program. The program is goal-oriented with a specific main objective and particular
expected outcomes.
The situational leadership model is appropriate in cases where employees of different
levels of competence and professions are involved. This initiative program is set in a clinical area
where different healthcare workers provide health care services to the patients (Lynch, 2015).
Collaborative care plans incorporate input from the patient and their family members (Eamer et
al., 2018). Collaborative assessments through screening identify the factors that predispose the
patient to potential harm and deaths and level of risks of developing new complications that
account for surgical mortality.
LEADS Framework
LEADS framework is also appropriate for application in the implementation of the
initiative program. The framework focuses on an innovative and integrated approach to
leadership in healthcare. The framework entails leadership at the individual, health institution,
and healthcare system levels (Dickson & Van Aerde, 2018). The framework states the necessary
skills, knowledge, behavior, and capabilities of different settings. The framework is applicable in
circumstances where leaders require self-motivation, engagement with other stakeholders,
performance of goal oriented tasks, collaboration and transformation of whole systems. The
framework is appropriate in the implementation of this healthcare initiative programs. The
LEAD framework is required in cases where certain goals need to be achieved. This initiative
program is directed by the overall objective and specific expected outcomes for each of the
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activities undertaken. In LEADS framework, leaders collaborate with other stakeholders to
implement the program. One of the activities soft in the program is to use collaborative approach
to reducing surgical mortality deaths (Fenwick & Hagge, 2016). Further, according to the
LEADS framework domains, leaders align their actions with strategies that are evidence based.
The initiative to rescue surgical mortality requires a continuous surveillance data collection to
evaluate quality and performance outcome in the surgical patient care.
Sustainability for the program will be achieved through collaboration and engaging other
stakeholders. The initiative will be communicated to other employees and the hospital
administration. Employees will be taught on the aims of the initiative, engage them actively and
reward them for adhering to the program goals. The hospital management will promote the
sustainability of the initiative through financial and technical support. The implementation of the
program requires funding which will be granted by the management (Gillissen et al., 2015).
Long term existence of the programs will be achieved through the development of further long
term goals and activities based on the existing initiative program goals.
In conclusion, there is inconsistency in the decline of surgical mortalities in Australia.
Post-operative infections are one of the causes of deaths in any surgical ward. Therefore, there is
need to implement programs to decrease surgical mortality rates in Australia. The specific
activity aims at obstructing the transmission infectious agents. This program aims at further
reducing surgical mortalities in given surgical ward. The program’s activities entail;
comprehensive documentation, early symptom recognition, collaborative approach and
continuous surveillance. Infection prevention will involve the nurse manager’s supervision of
buildings, equipment, and processes in the ward. Further, infection prevention will aim at
effectively changing the attitudes of the health care workers in the ward. Accurate and
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comprehensive documentation strategy initiative will reduce the rates of misdiagnosis. The
different activities by various healthcare professionals involved include; integration of input
from other clinicians involves sharing assessment data, multidisciplinary ward round reports and
application of appropriate communication strategies among the clinicians. Further, one of the
activities outlined in the healthcare initiative is the collaborative approach to its implementation.
Misdiagnosis is caused by failure to identify symptoms that require immediate care surgical
patients. “The World Health Organization’s My 5 Moments for Hand Hygiene” guidelines will
offer applicable, evidence based and easy to use guidelines on when to wash hands. Situational
leadership theory and LEADS model will guide implementation of the initiative program.
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References
Beiles CB, Retegan C, Maddern GJ (2015) Victorian Audit of Surgical Mortality is associated
with improved clinical outcomes. ANZ J Surg 85:803–807.
Chan, J. C., Gupta, A. K., Babidge, W. J., Worthington, M. G., & Maddern, (2019). Technical
factors affecting cardiac surgical mortality in Australia. Asian Cardiovascular and
Thoracic Annals
Chen, A., Retegan, C., Vinluan, J., & Beiles, C. B. (2017). Potentially preventable deaths in the
Victorian audit of surgical mortality. ANZ journal of surgery, 87(1-2), 17-21.
doi.org/10.1111/ans.13804.
Davis S. S., Babidge, W. J., Kiermeier, A., Aitken, R. J., & Maddern, G. J. (2018). Perioperative
mortality following oesophagectomy and pancreaticoduodenectomy in Australia. World
journal of surgery, 42(3), 742-748.
Dickson, G., & Van Aerde, J. (2018). Enabling physicians to lead: Canada’s LEADS framework.
Leadership in Health Services, 31(2), 183-194.
Eamer, G., Taheri, A., Chen, S. S., Daviduck, Q., Chambers, T., Shi, X., & Khadaroo, R. G.
(2018). Comprehensive geriatric assessment for older people admitted to a surgical
service. Cochrane Database of Systematic Reviews, (1).