WTP7.09 Transitioning to a Firm-Based System in General Surgery: A Quality Improvement Project

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Abstract Aim Traditional small surgical firms were associated with several benefits. Surgical firms were introduced as part of a quality improvement project within a district general hospital general surgery department in England following departmental expansion. Methods A Plan-Do-Study-Act framework was utilised. Three surgical firms were formed, each with 3 to 4 consultants. Resident and trust-grade doctors rotated firms at 6 monthly intervals. Clinician rota coordinators allocated doctors to elective duties based on their firm with occasional cross-cover. Firm Teams (Microsoft, USA) and WhatsApp (META, USA) communication channels were created. An electronic survey evaluated participant perceived benefits across 11 clinically relevant domains before and after implementation. The scores for each of these domains were analysed using Chi-Square and Wilcoxon signed rank tests. Data were collated using Office Forms (Microsoft, USA), analysed using Excel (Microsoft, USA) and SPSS (IMB, USA). Results Twenty six of 38 eligible participants took part in the survey (68% uptake; Consultants=6; other grades=20). The participant perceived score for continuity of care was significantly higher following implementation (p<0.05). The participant perceived overall benefit score was also significantly higher post-implementation (Z=6.315, p<0.001). Whilst a higher proportion of clinicians reported benefits post-implementation within the remaining 9 clinically relevant domains, there was no statistically significant difference after compared to before. Years worked in general surgery or familiarity of firm-based systems did not significantly impact participants favouring surgical firms (p>0.05) Conclusion Clinician participants reported several benefits introducing a firm-based system within this general surgery department. Further refinements and ongoing evaluation needed to ensure sustainability.

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