THIS institute: Developing a framework and core indicators for measuring good quality perioperative care (10 September 2025)

Summary

Nearly 10 million people have surgery in the UK each year, making it vital to monitor the quality of care they receive before, during and after their operation. To understand care quality, three key aspects of surgery are important: First, “structure” indicators look at aspects of healthcare organisation and structure, such as having the right number of staff and correct equipment in place. Second, “process” indicators look at actions taken during the course of caring for patients – such as providing pain management after the operation. Finally, “outcome” indicators assess how well the patient is doing following surgery, looking at things such as mobility and range of function.

Content

There is no shortage of indicators for monitoring surgical care – many hundreds have been published or used. But they aren’t all well-supported by evidence, and few include input from patients and healthcare staff. The authors of this study wanted to develop an evidence-based framework of the key aspects of structure and process important to quality, and to identify a set of indicators that reflect good care. They reviewed the available literature and shared their findings with a small group of patients, carers, healthcare professionals, and managers. They helped to identify 10 major categories that could be used to classify perioperative structure and process indicators, which were:

1. place, environment, facilities and equipment
2. leadership, management and governance
3. organisational culture
4. shared decision-making and partnerships
5. multidisciplinary working, teamwork and care co-ordination
6. patient optimisation and preparation (preoperative assessment and care)
7. availability and use of clinical care protocols, policies and guidelines
8. care after surgery, discharge, follow-up and support
9. staff education, training and competence
10. workforce planning, capacity and support

The authors used these categories to organise over 600 indicators – ranging from preparing patients well for surgery to supporting patients and carers to make informed decisions. Then, with the help of more than 250 patients and professionals, and following intensive workshops, they identified which were the most important indicators within each category.

The final framework, with its 10 categories and 28 core indicators, will be valuable for monitoring quality of care, helping to show where care is good and where improvement can be targeted.