Barry Appleton is a Consultant Colorectal and General Surgeon at Princess of Wales Hospital, Bridgend and Neath Port Talbot Hospital. He is the South Wales Chapter representative for the Association of Coloproctology of Great Britain and Ireland, and the South Wales network lead for colorectal cancer multidisciplinary teams.

Since qualifying with undergraduate (1989) and post-graduate (1991) degrees from St John’s College Cambridge, Barry has pursued a surgical career. He was awarded a higher surgical degree in 2004.

In 2005 his final training position was as colorectal surgical fellow at Flinders Medical Centre in Adelaide, Australia. There he was influenced by the surgical directorate lead surgeon who led quality improvement transformation of a large surgical department. Barry was so impressed by this work and the potential for improvement; he began adopting the methods he had seen used.

Inspiring improvement

During his year in Boston, Barry focused on two areas of work within emergency surgery. The first was looking at emergency surgery admissions and helping to develop smoother processes linking functioning healthcare bundles to optimise patient experiences and ensure safer care, while efficiently using resources.

‘A lot of complaints and poor outcomes are generated in emergency surgery. We are also troubled by frequent readmissions where outcomes could be better and the resources used far more wisely,’ Barry explained. ‘I will be able to learn a lot from the IHI’s experience of their Triple Aim approach.’

The Institute for Healthcare Improvement’s (IHI) Triple Aim initiative is an approach developed by the IHI that describes a framework for optimising health system performance.

His other, broader project was looking into whether there is a way of instilling a culture of quality improvement in the world of surgery.

‘We need to look for new ways to improve. The era of audit has taken us so far, and clinical governance took us onwards. Both are fundamental to quality assurance and must continue, but it is my view that both have reached their logical conclusion. Now it’s time for quality mprovement to drive us over the next big hurdle.’

Driving cultural change

When Barry returns to the UK he plans to work closely with the Association of Coloproctology looking at ways to overcome what he describes as ‘50 years of culture that ensured all power and responsibility necessarily rests with surgeons’. He feels that in this extremely complex, modern era, surgeons need to remain in genuine leadership roles, but it is impossible and unsustainable for them to maintain this approach in isolation. He aimed to inspire colleagues to change the future of surgery to one based on genuine teamwork, better utilising the skills of all healthcare providers, and encouraging a systematic, process-driven approach.