The Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) is the quality improvement and clinical effectiveness programme for the Oral and Maxillofacial Specialty (OMFS).

By collecting the data of patients treated for conditions affecting the head and neck and recording their outcomes, QOMS will be able to assess and measure the quality-of-care provided by OMFS departments in the UK. QOMS wants to identify best performers against any given metric across the NHS, quality assure that data and then generalise the care practices that underpin it by case studies, newsletters, presentations at conference, as well as BAOMS website content. Where performance falls significantly below the mean, and data checking confirms that to be the case, the Association intends to provide mentorship for change.

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Over the past couple of decades, escalating healthcare expenditure in the NHS has become unsustainable, and service commissioners need to provide cost-effective surgical procedures that demonstrate clear health benefits in line with best evidence-based practice. Patients should also expect, and demand, high quality care and the best possible surgical outcomes from OMFS.

The specialty has lagged behind other surgical specialties in publication of clinical outcomes across the UK (McMahon et al. 2018, Ho et al. 2021). This crystallised in 2018 when the Getting It Right First Time (GIRFT) initiative published their first OMFS report, which highlighted the lack of systematic clinical outcome measures in place, thus limiting opportunities for the specialty:

• To understand if care was being delivered in line with standards
• For providers to benchmark themselves against others
• To support continuous improvement.

Recommendation 5 of the GIRFT report was to "Deliver an efficient and patient-focused outcomes audit programme for oral and maxillofacial surgery”.

Under the late Ian Martin’s Presidency (2018), and with the support of Council, BAOMS initiated QOMS. This reflected the President’s view that implementing systematic quality improvement in OMFS and ensuring effectiveness of care provided based upon appropriate metrics were key to the continued successful development of surgical care in the NHS and reflected the core culture of the Association.

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To set up and develop a sustainable quality management and clinical effectiveness programme that delivers continuous improvement in the care of patients undergoing OMFS, within all parts of the NHS and demonstrates health-related benefits to patients from selected core OMFS activities.

QOMS objectives

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QOMS operates a series of clinical registries to collect data across OMFS practices or workstreams in the British Isles to drive:

• Quality improvement (audits or service evaluations)
  • Oral and Dentoalveolar surgery 
  • Trauma 
  • Non-melanoma skin cancer 
  • Oncology 
  • Reconstruction 
  • Orthognathic surgery 
  • Temporomandibular joint 
• Clinical effectiveness and surveillance (disease- and procedure-specific registries)
  • Salivary Gland Cancers registry 
  • Rare and benign Lesions of the Jaws registry
  • BAOMS BOS Orthognathic PROM 

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QOMS exists in parallel to other already existing registries and quality improvement initiatives (see below).

• Previous iterations of a Temporomandibular Joint (TMJ) Replacement Registry are now defunct and TMJ Replacement surgeries should be captured in the QOMS TMJ Replacement registry. 
• The National Clinical Improvement Programme (NCIP) from NHS digital and The Getting It Right First Time (GIRFT) initiative in England. Both initiatives are using data from the NHS Health Episode Statistics (HES) database. Efforts are underway to develop embedded case validation of QOMS data and HES data which is then represented in the NCIP OMFS dashboards. This is for the benefit of the surgical community to improve credibility in presented activity and outcome data.
• UK National Flap Registry (UKNFR) is led by the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS). One of the aims of QOMS over its 2025-2027 cycle is to develop a partnership with UKNFR to share data and avoid duplicate recording of OMFS flap activity.

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QOMS is overseen by the BAOMS Council and the QOMS Steering Committee. As of January 2025, the QOMS team is led by Mr David Tighe, QOMS Clinical Lead and two deputy leads, Ms Elizabeth Yeung and Mr Sam Kent. The QOMS Project manager, Dr Fabien Puglia, is responsible for the day-to-day activities of the project.

The project team also include:

• The Information Governance Group (IGG), which deals with all information governance issues. The IGG includes Mr David Tighe, Ms Elizabeth Yeung, Mr Sam Kent, Mr Jeremy McMahon (Caldicott Guardian), Dr Marisa Mason (National Confidential Enquiry into Patient Death and Outcome, NCEPOD) and Dr Fabien Puglia.
• The Audit and Registry working groups (see individual registry’s descriptions): Mr Geoff Chiu, Mr Panayiotis Kyzas, Professor Ashraf Ayoub.
• Trainee representative: Ms Harmony Ubhi.
• A Patient and Public Involvement group made up by patients and lay members to represent the opinions and voices of patients from different subspecialties.   

Structure of the QOMS project

Figure 2

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2018-2019: Project development

• Consultation with BAOMS SSIG Leads and Deputy Leads about what shape the initiative should take, which OMFS subspecialties would be involved and which metrics to measure
• Development of QOMS Protocol, questionnaires
• Selection of a IT solution for data collection and storage
• December 2019 -March 2020: launch of the QOMS first pilot in 6 OMFS units in England to test the online system, the registries and data collection processes locally.

2020-2021: COVID

• The initial QOMS pilot was cut short by a few weeks by the start of the COVID pandemic. QOMS activity was put on hold during that time.
• The results of the pilot were:
  • The content, structure and flow of the registries needed to be improved. This was undertaken by the newly appointed QOMS Audit Groups and the SSIGs. Ho et al. (2021) BJOMS.
  • Consenting patients for QOMS was identified as a hurdle. It was difficult to implement locally and increased clinicians’ workload. Where possible, it was decided to apply to devolved authorities to gain approval to collect patient (identifiable) information without consent.
  • Surgeon-led data collection was not sustainable.
• The QOMS Team ran several snapshot audits looking at the impact of the pandemic on the provision of care for OMFS trauma and cervico-facial infections. Find out more here.

2021-2024: Addressing surgeon-led data collection - QOMS Second Pilot

• The initial pilot showed that surgeon-led data collection was not sustainable. In response, the Association decided to fund 10 OMFS units to employ a part-time data coordinator to effectively support high-quality and comprehensive data collection with the help of the hospital Clinical Lead.
• This pump-priming grant was a 3-year pilot to demonstrate the importance and value of encouraging NHS Trusts and Health Boards to support this process in the long term.

• Appointed data coordinators worked closely with the local QOMS clinical lead and other surgeons to collect and update data for the project. Behind that 3-year initial funding, BAOMS hoped that OMFS departments would be able to secure local funding from their NHS Trusts and Health Boards to continue data collection or to start taking part to the QOMS.
• BAOMS-funded departments could join as soon as they had successfully hired a data coordinator and obtained Trust/ Health Board approval for QOMS (see below)
• The second pilot finished in 2024 for most contributing hospitals and was a mixed success.

2021-2024: QOMS first data collection cycle

• QOMS was rolled out nationally in July 2021 to every OMFS unit and/or surgeon in the UK. This was effectively the initiation of the definitive QOMS data collection process.
• The QOMS Team applied to the Confidentiality Advisory Group (CAG) for section 251 support for England and Wales and to the Public Benefit and Privacy Panel for Health and Social Care (PBPP) for Scotland. Approvals were obtained in 2020 and 2022 respectively.
• At the end of the 1^st year of data collection, the QOMS Team censored the data and produced the QOMS Inaugural report 
• Following the publication of the 1^st report, extensive changes were made to the Trauma registry, which was then closed and split into two separate registries (Mandible and Isolated orbital wall fractures). The new registries went live on July 14^th, 2024.
• In September 2023, following a FlexFacs Masterclass on Review of salivary gland cancers, the new QOMS Salivary Gland Cancers registry was launched. 
• In December 2023, the launch of the new QOMS Rare and Benign Lesions of the Jaws registry was accompanied by a Flexfacs session on the management of those conditions. The recording of the session is available here. 
• Another virtual masterclass was held in May 2024 on “Patient-specific implants for mandibular reconstruction” to raise awareness for this new module to the QOMS Oncology & Reconstruction registry.
• QOMS audits were added to the NHS Quality Accounts list for 2024-2025
• The 2^nd QOMS report was published in June 2025 and include the whole “summer 2021” to “summer 2024” period.

2025-2028: QOMS second data collection cycle

• New cycle, new leadership. David Tighe took over form Michael Ho as QOMS Clinical Lead and has recruited two deputies, Elisabeth Yeung and Sam Kent, to look after engagement/collaboration and data.A new workstream has been added for temporomandibular joint (TMJ) which contains two audits, developed by the TMJ SSIG: TMJ Arthroscopy and TMJ Replacement registries. Find out more here 
• The Paediatric SSIG is also hoping to launch a new Paediatric OMFS audit, they have been working on. Watch this space!

The plans for this next phase of QOMS are:

• To develop partnerships with GIRFT (for patient case validation) and UKNFR (for duplicate recording of OMFS flap activity and importantly outcomes)
  • To explore opportunities for QOMS to have elements of its dataset populated by data sharing with NHS organisations to reduce the intensity and demand on manual data entry requirements
• To improve graphic interface and user experience to optimise and enhance real-time utilisation of clinical outcome outputs
• To pPromote and encourage embedding QOMS in local clinical governance processes with the support of BAOMS Council, RSPAs and SSIG Committees

The QOMS experience in Glasgow

Watch on YouTube: This video is an extract of the webinar held by the QOMS Team in November 2020 

Webinar links to videos:

• December 2020 
• January 2021 

Two webinars for OMS surgeons were held in 2020 and 2021 to introduce QOMS to a wider audience, present the 2^nd phase of the project and offer an opportunity to participants to ask questions directly to the team. Both include a short presentation by Jeremy McMahon, which was extracted from the 2020 webinar. It shows how QOMS could be used to assess performance of clinical care locally and direct future quality improvement work.

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1. McMahon J, Puglia F, Martin I, et al. Measuring health-related benefit and quality of care in oral and maxillofacial surgery: British Association of Oral and Maxillofacial Surgeons Outcomes Project. British Journal of Oral and Maxillofacial Surgery 2018;56:439–43. https://doi.org/10.1016/j.bjoms.2018.05.016
2. Ho MW, Nugent M, Puglia F, et al. Results of flap reconstruction: categorisation to reflect outcomes and process in the management of head and neck defects. British Journal of Oral and Maxillofacial Surgery 2019;:S0266435619303213. https://doi.org/10.1016/j.bjoms.2019.08.005
3. Ho MW, Puglia F, Tighe D et al. BAOMS QOMS (Quality and Outcomes in Oral and Maxillofacial Surgery): a specialty-wide quality improvement initiative, progress since conception. British Journal of Oral and Maxillofacial Surgery 2021 DOI: https://doi.org/10.1016/j.bjoms.2020.12.023 (accepted)
4. Ho MW, Puglia F, Tighe D et al. BAOMS QOMS: findings from the pilot phase and lessons learned in the feasibility evaluation of a national quality improvement initiative. British Journal of Oral and Maxillofacial Surgery 2021 DOI: https://doi.org/10.1016/j.bjoms.2021.02.015 (accepted)
5. COVIDTrach collaborative. COVIDTrach; the outcomes of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK: Interim Report. Br J Surg. 2020 Nov;107(12):e583-e584. https://doi.org/10.1002/bjs.12022. Epub 2020 Sep 17. PMID: 32940347. 
6. Hamilton N, Schilder A, Jacob T, et al. COVIDTrach; a prospective cohort study of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK. medRxiv 2020;:2020.10.20.20216085. https://doi.org/10.1101/2020.10.20.20216085
7. Puglia FA, Hills A, Dawoud B, et al. Management of oral and maxillofacial trauma during the first wave of the COVID-19 pandemic in the United Kingdom. British Journal of Oral and Maxillofacial Surgery 2021;:S0266435621000140. https://doi.org/10.1016/j.bjoms.2020.12.021
8. Puglia FA, Ubhi H, Dawoud B, et al. The management of odontogenic cervicofacial infections presenting to Oral and Maxillofacial Units during the first wave of the COVID-19 pandemic in the United Kingdom. British Journal of Oral and Maxillofacial Surgery 2021;:S0266435621000012. https://doi.org/10.1016/j.bjoms.2020.12.017
9. Ho MWS, Tighe DF, Puglia FA. A major milestone for quality improvement in the history of the British Association of Oral Maxillofacial Surgeons (BAOMS): publication of the inaugural Quality and Outcomes in Oral and Maxillofacial Surgery (QOMS) report. British Journal of Oral and Maxillofacial Surgery 2023;61:123. https://doi.org/10.1016/j.bjoms.2023.02.001
10. Puglia F.A. and Chiu G.A. Comparison of oral and maxillofacial trauma during the first and third lockdown of the COVID-19 pandemic in the United Kingdom. British Journal of Oral and Maxillofacial Surgery 2022;60:465. DOI: https://doi.org/10.1016/j.bjoms.2021.08.005
11. The British Association of Oral and Maxillofacial Surgeons (2023) The Quality and Outcomes in Oral and Maxillofacial Surgery Project Inaugural Report 2021-2022 Ho MWS, Tighe DF and Puglia FA ISBN: 978-1-7393066-0-1
12. The British Association of Oral and Maxillofacial Surgeons (2023) Technical appendix - Validating risk-adjustment models used in QOMS Tighe DF, Sassoon I, Provost S, Puglia FA, and Ho MWS
13. The British Association of Oral and Maxillofacial Surgeons (2025) The Quality and Outcomes in Oral and Maxillofacial Surgery Project Second Report 2021-2024 Ho MWS, Tighe DF and Puglia FA ISBN: 978-1-7393066-1-8

QOMS Project resources:

• QOMS short protocol: for an up-to-date project protocol and starter pack contact Fabien Puglia, QOMS Project Manager
• QOMS Starter pack: for an up-to-date project protocol and starter pack contact Fabien Puglia, QOMS Project Manager
• How to register to REDCap: send the project manager the names, work emails and position of individuals requiring access to REDCap. If more than 5 persons, the Project Manager can provide you with spreadsheet to fill in instead. 
• QOMS Privacy and Fair processing policy

Generic patient-facing documents for the QOMS audits (please refer to specific pages for the consented audits & registries):

• England: Leaflet, A3 poster & A4/5 poster
• Wales: Leaflet (English | Welsh), A3 poster (English | Welsh) & A4/5 poster (English | Welsh)
• Scotland: Leaflet & A4/5 poster

Quality improvement resources:

• QOMS Data burden reduction strategy (October 2024)
• QOMS Health care improvement plan (October 2024)
  • Fishbone diagram template
  • Driver diagram template

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BAOMS QOMS Clinical Lead: David Tighe

I am a Consultant Head and Neck and Reconstructive Maxillofacial Surgeon based in Kent.  I have an interest in developing risk adjustment algorithms for key early outcomes after Head and Neck Surgery for Cancer.  I have an active collaboration with the Computer Sciences department at the University of Kent.  Our speciality deals with a particularly complex and diverse group of pathologies and patients.  The QOMS project is a fundamental step our speciality needs to take to describe and improve quality of care throughout the UK.  

BAOMS QOMS Clinical Deputy Lead: Elizabeth Yeung

(Biography to follow)

BAOMS QOMS Clinical Deputy Lead:  Sam Kent 

(Biography to follow)

BAOMS QOMS Project manager:  Fabien Puglia 

(Biography to follow)

BAOMS QOMS Caldicott Guardian: Jeremy McMahon

I am a surgeon and a member of the head and neck and maxillofacial surgery teams in Glasgow – my home now for nearly two decades.

QOMS is the brainchild of Ian Martin who used his president’s discretionary fund to get it off the ground in 2018. It was an inspirational lightbulb moment for me and I became involved immediately. Ian, ever shrewd, immediately co-opted Marisa ( – a stroke of genius) who was largely responsible for the recruitment and mentoring of the indefatigable Fabien and cleverly guiding the rest of us on this journey.  Involvement in this project has been the most gratifying aspect of what has been a compellingly interesting, rewarding and enjoyable career, not just because the project is so worthwhile and important- but also because of the many truly outstanding individuals I have met as a result of it. I don’t wish to name them- they know who they are!

As a surgeon I have always thought that empiricism and the truths (albeit ephemeral at times) it reveals must lie at the core of the what, why, when, and how of surgical endeavour. Extending empirical methodology to surgical quality management systems is the logical 21st century extension that is fast becoming the norm for all surgical specialities. BAOMS leadership in this journey is something we can all be justifiably proud of- it is up to us the exploit the opportunity it presents -to use comparative data to help us realise our individual surgical potential and help each other deliver the best possible surgical care for patients.

Please email me, phone me, speak to me at meetings if you have any doubts, queries, suggestions, enthusiasm for QOMS- you will find me a very willing audience!

BAOMS QOMS Immediate Past Clinical Lead: Michael Ho

Michael Ho is Consultant in Maxillofacial Oncology in Leeds Teaching Hospitals NHS Trust providing an outreach service to the Mid Yorkshire NHS Trust. He was the BAOMS Reconstruction SSIG Lead (2015-2020) and has been a member of the BAOMS QOMS working team in the capacity as Clinical Communication Lead (2018-2020). He has co-edited the Head and Neck section of the first UKNFR (UK National Flap Registry) report which was published in December 2019 and has in collaboration with surgical colleagues nationally developed a classification system of flap reconstruction outcomes in the head and neck (doi: 10.1016/j.bjoms.2019.08.005), as part of the development of the BAOMS QOMS Reconstruction Audit, which will be incorporated to the next iteration of the UKNFR. He has engaged in local quality improvement initiatives to screen for preoperative anaemia in elective head and neck surgical patients and is the specialty lead for the PQIP (Perioperative Quality Improvement Project) in Leeds General Infirmary. He is also one of the Training Programme Directors for Core Surgical Training in Yorkshire and currently serves as Lead Clinician for Head and Neck Cancer for the Leeds-Mid Yorkshire multidisciplinary team. During the COVID-19 pandemic period, he was the local BAOMS COVID-19 lead and he has been a member of the writing team for several initiatives by the COVIDSurg Collaborative as one of the Head and Neck International Cancer Leads.

The Audit and Registry working groups:

Oncology-Reconstruction and Skin cancer Lead: Panayiotis Kyzas

My name is Mr Panayiotis (Panos) Kyzas. I am a consultant in OMFS/Head and Neck Surgery with a clinical specialty interest in ablation and reconstruction of head and neck cancer and facial skin cancer. I have completed a TIG H&N fellowship in advanced head and neck surgical oncology and I am a JCST-recognised Head and Neck Surgeon. I am an accredited microvascular reconstructive surgeon, a GMC-recognised surgical trainer and a fellow of BAOMS and RCSEd in good standing. I have joined the RCSEd faculty of surgical trainers (FST). I am currently the Regional Specialty Advisor (RSPA) for OMFS, a post jointly supported by RCS/BAOMS/FDS. I am the OMFS section Lead for the QOMS project for H&N Cancer, Facial Skin Cancer and H&N reconstruction. I have graduated both my medical and dental degrees with honours, and I have won multiple scholarships, bursaries and awards throughout my undergraduate and postgraduate years of training. 

Throughout my career I have been heavily involved in research, education, teaching and training and I have a special interest in surgical innovation and service development - details in my CV. I have published over 60 peer reviewed papers and I have over 5000 citations. I am the Editor for BJOMS, and I have a special interest in patient-specific reconstructive planning with the use of 3D printer technology 

Trauma and Oral and dentoalveolar surgery Lead: Geoff Chiu

I am a consultant in Oral and Maxillofacial Surgery at East Lancashire Hospitals and at Royal Bolton Foundation Trust, specialising in Deformity, Trauma and Reconstructive Surgery.  I currently lead the implementation of new the IT services into the department. I’m one of the appraisers for the Trust and organize the weekly teaching sessions for the junior doctors. I am one of the research leads for the Saving Faces Charity, a reviewer for Specialty’s International journal and a core member of the National quality outcomes project for the Specialty. I’m an examiner for the Royal College of Surgeons of England.  Outside of work I compete in Triathlons.

Orthognathic surgery Lead: Ashraf Ayoub 

(Biography to follow)

Trainee representative: Ms Harmony Ubhi 

(Biography to follow)

QOMS is also supported by external advisors and collaborators:

Marisa Mason Chief Executive Officer: National Confidential Enquiry into Patient Outcome and Death NCEPOD

Marisa joined NCEPOD in 2002 after completing her PhD at King's College Hospital and post-doctoral research at St George's Hospital, both in stroke prevention.  Originally joining NCEPOD as a Project Manager, she took over as Chief Executive Officer in 2006 and has been part of the many changes and exciting challenges that have faced the organisation over the last 15 years; including the extension of NCEPOD’s remit to include mental health and primary care and the addition of the Child Health Clinical Outcome Review Programme. Marisa has a strong interest in using data efficiently to improve the quality of care provided to patients, whilst respecting information governance to maintain patient and clinician confidentiality. It is this interest in the use of data for quality improvement that has led her to be involved in QOMS.

See also: 

• Saving Faces 
• Salivary Gland Cancer UK 
• The Oracle Head and Neck Foundation