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BMJ Qual Saf. 2019 Sep;28(9):721-728. doi: 10.1136/bmjqs-2018-008797. Epub 2019 Mar 28.

Use of performance reports among trauma medical directors and programme managers in the American College of Surgeons' Trauma Quality Improvement Program: a qualitative analysis.

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Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
Trauma Quality Improvement Program, American College of Surgeons, Chicago, IL, USA.
Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.



The American College of Surgeons' Trauma Quality Improvement Program (TQIP) provides trauma centres with performance reports on their processes and outcomes of care relative to their peers. This study explored how performance reports are used by trauma centre leaders to engage in performance improvement and perceived barriers to use.


Qualitative focus group study with trauma medical directors (TMDs) and trauma programme managers (TPMs) in US trauma centres. Consistent with qualitative descriptive analysis, data collection and interpretation were inductively and iteratively completed. Major themes were derived using a constant comparative technique.


Six focus groups were conducted involving 22 TMDs and 22 TPMs. Three major themes were captured: (1) technical uses of performance reports; (2) cultural uses of performance reports; (3) opportunities to enhance the role and value of TQIP. First, technical uses included using reports to assess data collection procedures, data quality and areas of poor performance relative to peers. In this domain, barriers to report use included not trusting others' data quality and challenges with report interpretation. Second, reports were used to influence practice change by fostering inter-specialty discussions, leveraging resources for quality improvement, community engagement and regional collaboratives. Perceived lack of specialist engagement was viewed as an impediment in this domain. Lastly, identified opportunities for TQIP to support report use involved clarifying the relationship between verification and performance reports, and increasing partnerships with nursing associations.


Trauma centre improvement leaders indicated practical and social uses of performance reports that can affect intention and ability to change. Recommendations to optimise programme participation include a focus on data quality, adequate resource provision and enhanced support for regional collaboratives.


performance improvement; qualitative analysis; quality improvement program; trauma center


Conflict of interest statement

Competing interests: AN is Medical Director of the American College of Surgeons’ trauma quality programmes. CH is Manager of Data and Report Operations at American College of Surgeons. MN is Program Manager, Trauma Quality Improvement Program at American College of Surgeons.

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