IDEAL framework

IDEAL (Idea, Development, Exploration, Assessment, Long-term study) is a framework for describing the stages of innovation in surgery and other interventional procedures. The purpose of IDEAL is to improve the quality of research in surgery by emphasizing appropriate methods, transparency of data and rigorous reporting of outcomes.

To achieve this, the IDEAL framework provides a set of recommendations for improving the evidence base from research at each stage of innovation, as outlined in the seminal paper published in The Lancet in 2009. The recommendations emphasize evaluating new procedures prospectively, entering patients and studies into registries and databases to capture all incidences of a procedure, and reporting outcomes by established protocols. It is the first and only such framework for evidence-based practice that was established specifically for surgery and interventional procedures.

The IDEAL framework was the result of an expert consensus developed from a series of meetings held at Balliol College, Oxford from 2007-2009. This group was known as the Balliol Collaboration. The purpose of the meetings was to address the challenges unique to establishing the optimal evidence base in surgery, including practical, methodological, and ethical challenges. Attendees to the meeting (the “IDEAL collaboration”) included experts in evidence-based medicine, including Cochrane Collaboration founder Iain Chalmers, public health expert Muir Gray, statistician and founder of the Centre for Statistics in Medicine in Oxford Doug Altman, clinician-researchers, methodologists, and manufacturers of medical devices.

The five stages of IDEAL, and the recommendations for each stage, are as follows:

In the original publication in The Lancet, the authors outline a number of proposals for key stakeholders in the generation of surgical evidence. These include journal editors, funders of services and research, regulators, and professional societies.

The original IDEAL collaboration consists of attendees to the Balliol meetings. Subsequent members include other stakeholders in evidence-based surgery and interventional procedures. The IDEAL collaboration is led by Oxford surgeon-researcher Peter McCulloch.

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