Patricia L. Turner, MD, MBA, FACS
June 7, 2023
It is no secret that the American College of Surgeons puts great emphasis on quality improvement. Improving the quality of surgery was a key impetus for the College’s founding in 1913. Our first formal quality improvement initiative, the Hospital Standardization Program (a precursor of The Joint Commission), was launched in 1918.
More than a century later, nearly every aspect of surgical practice, from technology to decision-making to patient needs, has shifted in ways that our founders might never have predicted—but the College’s commitment to quality improvement has remained constant. Today, we have 18 quality improvement programs in thousands of hospitals nationwide. We aim to make quality improvement a seamlessly integrated part of healthcare.
We know that most Americans receive their care in community hospitals, so these healthcare systems are just as important a focus for our Quality Programs as are academic medical centers. So far, we have engaged both types of institutions in our Quality Programs, with some notable successes.
First is a managed care consortium headquartered on the West Coast, which has 35 sites that participate in one to five ACS Quality Programs each, with many participating in our National Surgical Quality Improvement Program (NSQIP®) as well as geriatric and cancer-focused Quality Programs.
One division has recently partnered with the College to expand its use of NSQIP to evaluate ambulatory surgery centers. The project is still in the pilot phase and is working to scale up across healthcare centers. Early analyses have found somewhat surprising results. Despite ambulatory surgery centers’ general focus on lower-risk procedures in patients with fewer comorbidities than those treated as inpatients, their outcomes are not consistently better than inpatient care. Quantified comparisons of NSQIP and ambulatory center data on metrics such as surgical site infections and urinary tract infections offer opportunities for systematic improvements.
This is the kind of valuable information we seek in Quality Programs. As more and more procedures are performed on an outpatient basis, emphasizing quality in outpatient care is progressive and essential. Data demonstrating ways to improve care in this setting have the potential to impact an ever-increasing number of patients.
A healthcare system in New York state has implemented multiple Quality Programs in six of its hospitals, including the Geriatric Surgical Verification program in three hospitals. After collaborating with an ACS team, they realized that updating their electronic medical records would help create meaningful changes in geriatric surgery. Specifically, they reoriented clinical records to capture essential data on geriatric surgical care and improve communication among surgeons and advanced practice providers. They added new note templates, banners to identify geriatric surgical patients, and connections between episodes of care, as well as flowsheets for nurses noting important considerations for working with geriatric patients.
When these changes were made available to all team members, the result was that their records now closely match the fields in our Geriatric Surgical Verification Program—giving this healthcare system the means to track its progress in quality improvement and offer their patients the best care possible, as seamlessly as possible.
Finally, there is a healthcare system near Washington, DC, that has enthusiastically adopted ACS Quality Programs and become an exemplar of increasing quality by standardizing care. Standardization, although always a guideline and never a replacement for expert opinion, is often key to improving quality across a healthcare system—enhancing outcomes while reducing cost. This healthcare system has fully embraced this idea, resulting in significant gains in quality.
The key to its success is strong leadership at the system level. This engagement increases buy-in through the healthcare system, makes leadership transitions possible without a loss in momentum, and helps spread successes in one department to others by sharing contextually relevant solutions to practical problems.
In each case, the quality improvement process positions the ACS as a facilitator and champion of healthcare systems. The process of a site visit or verification visit minimizes imposition and emphasizes helping a healthcare system evaluate itself by reviewing its care processes, outcomes, and motivations for change.
Moreover, these efforts can help hospitals survive and thrive. We know that improving quality is imperative because serving patients to the best of our ability is the core of what we as surgeons do—but in these times, when financial issues can challenge community healthcare systems, the solid return on investment associated with quality improvement is vital, too.
Our overall goal is to create a Quality Program that is not just beneficial to clinicians, patients, and the system itself, but also one that is frictionless. Moreover, our aim is also to be ubiquitous. Our newest quality campaign, The Power of Quality, endeavors to bring our Quality Programs to every hospital and patient in the nation.
Of course, this means helping hospitals implement Quality Programs across many types of practices, specialties, and communities. Some hospitals and clinicians are well-versed in the quality improvement tradition already, and we are positioned to help them go from good to great. Others are at the beginning of their quality journey, and for them, we offer roadmaps for engaging in this work, including a brand-new framework, a primer, and didactics for team members. See more.
Just as all hospitals can (and should) implement Quality Programs, all surgeons can be advocates for quality. Communication is crucial to quality improvement, including to, from, and between frontline clinicians. So, we invite you, as surgeons, to become champions in your own environments, including communicating with hospital executives to amplify the quality conversation—and thereby building on what we as surgeons all want, which is to deliver high-quality care to our patients and be rewarded for exemplary work.
Throughout, the ACS aims to meet everyone where they are. We are all striving to be as effective as possible, and that is the power of quality in surgical care—as reflected in our 110-year-old motto, “To Heal All with Skill and Trust.”
For those engaged, intrigued by, or curious about the quality journey, there is still time to register for the Quality and Safety Conference. This year, we will meet in Minneapolis, Minnesota, from July 10 to 13. We look forward to presentations on all 18 ACS Quality Programs, as well as an address by our Director of the Division of Research and Optimal Patient Care, Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS. Register here and invite your colleagues to come along: facs.org/qsc2023.
Registration for Clinical Congress 2023, October 22-25, in Boston, Massachusetts, is now also open at facs.org/clincon2023. The schedule includes a huge range of presentations, lectures, and awards from across the House of Surgery. We look forward to seeing you and your colleagues there. In particular, we welcome all of our new initiates who will be inducted this year.
Please note that we are considering adding sessions on quality enhancement at Clinical Congress in the future—so if you are interested in this programming, please let us know.