Learning from best performers in colorectal cancer surgery

To evaluate and improve quality of colorectal cancer surgery clinical audit systems were introduced in several countries. One of the goals of a clinical audit is learning from ‘best practice’. The aim of this thesis was to learn about ‘best practice’ in colorectal cancer surgery. This was done by first identifying best performing hospitals and then investigate which structural, procedural and contextual factors are correlated with best performance in these hospitals.This thesis shows that the concept of best performance and ‘best practice’ may be too simplistic in everyday practice. It was not possible to reliably define a best performing (group of) hospitals on a combination of outcomes. However, specific outcomes could be helpful to identify starting points for improvement. Furthermore, it was not possible to identify a combination of structural or process measures necessary for good performance. To reach good outcomes, specialization and dedication of the ward and the team seem to be important. To reach best performance, ‘best practice’ seems to be: a specialized team with the right attitude and culture, effective teamwork and dedication to continuous improvement supported by continuous learning from reliable national and hospital specific data.Stichting DICA, KWF kanker bestrijding, Universiteitsbibliotheek Leiden, Stichting SBOHLUMC / Geneeskund