2025 Quality and Safety Conference Points to Bold Future of Surgical Quality

Members of the surgical quality improvement (QI) community are advancing the field in unprecedented ways. That was a key takeaway from the recent 2025 ACS Quality and Safety Conference (QSC), which took place July 17–20 in San Diego, California, with the theme “Embracing Change and the Future of Quality.”

Approximately 1,500 surgeons and other QI professionals attended the event, which celebrated the 20th anniversary of a meeting that began when the ACS adopted and expanded the National Surgical Quality Improvement Program (NSQIP) from the Veterans Administration.

“ACS NSQIP has changed the very culture of our surgical profession, and in doing so, all of us have improved the lives of millions of surgical patients,” said Bruce L. Hall, MD, FACS, from the University of California Davis Health in Sacramento, and Program Director for QSC.

Building on that history, Clifford Y. Ko, MD, MS, MSHS, FACS, Senior Vice President of the ACS Division of Research and Optimal Patient Care, discussed the significant step forward that is taking place with the new ACS clinical data strategy, which he announced in his opening remarks. 

The ACS has entered into an agreement with Epic Systems, the largest electronic health records (EHR) provider in the US. This agreement is part of a multiyear strategy that will involve several technology companies and will lead to the development of innovative solutions and tools to enhance how data are used and accelerate the QI process. 

“This strategy will make data collection less burdensome, less expensive, more efficient, broader, and simultaneously more detailed,” Dr. Ko said.

Throughout the conference’s General Sessions, speakers described current efforts to advance technology, methodology, and teamwork to bolster surgical QI.

HIT and Project Planning Drive the Future of Quality

The ACS data strategy is designed to decrease friction in the process of transmitting actionable data to researchers and those on the front line of patient care, and a major part of that efficient future will require the continuing evolution of health information technology (HIT).

“Clinical registries are foundational to our quality efforts, but they have room to improve. Human-intensive abstraction is retrospective and slow to adapt,” said ACS Chief Health Informatics Officer Genevieve Melton-Meaux, MD, PhD, FACS, from the University of Minnesota in Minneapolis.

She added that evolving data procurement platforms will include additional automation and injection of artificial intelligence (AI) into the data abstraction process to streamline usable data.

While the ACS data strategy speaks to a high-level vision for how technology and collaborations will advance quality surgical care, “small-scale, frontline QI—the kind performed by surgeons, nurses, registrars, quality officers, which the team actually touches and that patients experience—is essential,” Dr. Ko said.

To that end, the ACS collaborated with The Healthcare Improvement Studies Institute to develop the Early Planning of Small-Scale Surgical Improvement Projects (EPoSSI) Tool, which focuses on the critical early stages of project planning that lay the groundwork for success. The tools cover nine domains such as choosing an improvement team, developing aims, planning intervention implementation, and deciding on “go/no go,” among others.

“Small-scale efforts aren’t often published, and we don’t often know a lot about them—and yet, this is where frontline care happens. If we do these small-scale efforts better, a lot of care will get better for our patients” in a much shorter timeframe, Dr. Ko said.

AI Synopses of Operative Data Could Advance Training

As much as technology is changing QI and high-level decision-making, new developments may have an impact on training and care within the OR itself.

During a session on the future of surgery, Carla Pugh, MD, PhD, FACS, from Stanford University School of Medicine in California, spoke on how multimodal data capture is providing a level of personalized intraoperative feedback that could change how surgeons and trainees understand their strengths and weaknesses. The baseline starts with surgical video.

“The real benefit of AI is related to automated analytics. It can help find and deliver that short, 5–10 second video clip to review from a 4-hour procedure, which by itself saves considerable time and effort,” she said. From there, audio capture, electroencephalogram, and motion capture work in tandem with the video to provide a window into a surgeon's or trainee’s activities.

As an example, Dr. Pugh shared data from hand sensors during a macrovascular anastomosis. A side-by-side comparison showed a faculty surgeon operates with considerably greater efficiency, smoothness, and velocity than a trainee.

Nassib Chamoun, founder, president, and CEO of Health Data Analytics Institute also addressed current and near-future uses of AI within surgical care workflows.

He noted that AI could save a significant amount of clinician time managing patient information in the EHR by proactively designing the right patient workflow, aligning resources to needs, and delivering actionable insights at the point of care.

Chamoun described how his team has used AI to build hundreds of predictive models based on Medicare data for outcomes, utilization, and cost to understand performance at a granular level, with the next steps in development.

“You need to have a real-time platform that can process all these data and deliver the information not just to clinicians, but to every member of the care team on the front line,” Chamoun said, adding that generative AI agents are uniquely suited to this stratified aggregation and are able to deliver information that is fully transparent and traceable.

Reimbursement Models Affect Patient Care, Bottom Line

Not to be lost among conversations on the technology and new resources that will directly aid in surgical care is the critical role that reimbursement and measurement itself plays in supporting QI and patient safety—a role that can help or hinder patients and care teams.

The US healthcare system has long existed in a fee-for-service world, and that has led to fragmented care that does little to reward quality or outcomes, according to Mary Witkowski, MD, MBA, from Harvard Medical School and Harvard Business School in Boston, Massachusetts. 

Fee-for-service leads to a lack of transparency for patients and, importantly for QI professionals, “the time horizon is too short for payment to be tied to outcomes and not a meaningful way to do risk adjustment,” Dr. Witkowski said.

The solution to these issues is shifting to value-based care, “which not only would reward quality care, but also make the care horizon that matches the underlying health needs that physicians are working on for patients,” she added, describing promising models related to type 1 diabetes that are showing improved clinical outcomes for patients, cost savings for payers, and financial bonuses for providers.

But in the nascent days of experiments with value-based care, hospitals are still learning how to balance the improved outcomes of value-based care with uncertainty in costs, as Elizabeth C. Wick, MD, FACS, of the University of California San Francisco (UCSF), discussed.

Dr. Wick described how UCSF implemented a bundled payment system for bowel surgery, based on the Centers for Medicare & Medicaid Services Transforming Episode Accountability Model (TEAM) that will go into effect in 2026.

The UCSF version covered costs in a 90-day period after surgery, which included elective colorectal surgery, emergency rectal surgery, and others (TEAMS is a 30-day period). The initial payment was meant to cover all costs related to the care episode, including follow up, complications, and so on.

The planning work that went into this transition of reimbursement did make a beneficial impact for patients—but a difficult one for providers.

“In the first 2 years, it reduced complications, length of stay, and 90-day readmission, which are positive from the patient perspective. By year 3, the price per episode started to far exceed the payment, and the hospital bore the burden of $500,000 in extra cost,” Dr. Wick said.

The TEAM initiative, with its shorter period, may mitigate some of the extra costs, but surgeons will need to be prepared for potential issues while the payment system is implemented and refined, she said.

Crew Resource Management Is Critical for Surgeons

An intense OR is a work environment that few individuals outside of surgery are likely to understand—but fighter jet pilots like Keynote Speaker Jack Becker, a retired Captain in the US Navy, are well-versed in stressful situations.

In the Navy, he said that what mitigates the stress of operating—and making mistakes—in life-and-death situations is the concept of crew resource management.

This training system is built not upon strict hierarchy, where lower-ranking individuals must defer to higher-ranking professionals, but an environment that reinforces “the vulnerability of needing each member of our team to succeed in order for us all to succeed,” Captain Becker said.

Navy culture used to be, “the captain is always right,” and opinions were meant to be unspoken—a sentiment that surgeons may have experienced at some point in their careers. This kind of culture is liable to lead to a mistake due to human error, which leaders as well as team members will inevitably experience. It is critical to address an error when it is still manageable.

“Human error is unavoidable. Pilots and surgeons often can afford to make a mistake—but what your team cannot afford is repeated mistakes that lead to a culture of error,” Captain Becker said.

Crew resource management was designed to promote communication, assertiveness, leadership, decision-making, and other elements in all members of a team to create a high-functioning unit that is capable of the pursuit of perfection. To illustrate that point, he described the iterative process of standardizing the act of landing a supersonic jet on a nuclear-powered aircraft carrier.

“Every time I landed my F-18 on the aircraft carrier, I was asking them to find me a 14-inch window for the right approach. If they brought me in or I came 3 inches low, there was no blaming. We would say, ‘We’ll do it better next time,’ because we wanted the team to succeed,” he said.

The intent is to instill the idea of psychological security, where all members of the team are unencumbered to bring up thoughts, concerns, and outside-the-box ideas without ridicule of reprimand—all in service of preventing errors.

Relevant to surgeons and QI professionals was the concept of drift, where you let your standards slide “just a bit.”

“The most insidious thing that happens with drifting standards is that we get away with it,” Captain Becker said. You may be able to drift off your standardized workflow for a time without an issue, but that will eventually lead to a cascade of errors that can be life-threatening in the unforgiving work of pilots or surgeons.

After decades of experience in team-building, the Navy created a system that had aided pilots in pursuing perfection: Brief–Execute–Debrief–Perfect.

This system provides a formalized space to define expectations and roles (the brief) and to standardize communication during project execution. The debrief is the critical next step that allows invaluable lessons to be learned and rolled into the brief the next day, creating a cycle that will, ideally, allow the project, the flight mission, or the operation and patient experience to be perfected.

Multidisciplinary Efforts Lead to Perioperative Advancement

Surgeons are no doubt the de facto leaders within the OR, but to ensure high-quality patient outcomes and safety, all parts of the perioperative care team must work together and strengthen one another.

As the frontline providers who interact the most with patients, nursing teams have played an integral role in perioperative advancement in recent years, according to Nakeisha Tolliver, DNP, MBA, RN, NE-BC, CNOR, CSSM, from The University of Texas Health Science Center at Houston and the Association of periOperative Registered Nurses.

In addition to technological advancements that nurses have a major role in managing, implementation of World Health Organization Surgical Safety Checklists made nurses central to team compliance, timeouts, and prevention of never events.

“This has made nurses champions and frontline leaders in compliance and continuous improvement,” Tolliver said, adding that the shift from task-based to team-based care has leaned into nurses’ strengths as communicators and patient advocates while growing the expectation for critical thinking and process improvement.

As the OR and hospital of the future become increasingly integrated through data-driven care models and technology, such as AI-driven precision surgery, the perioperative nurses will need to continue growing their skills, she said. Future roles for nurses will include informatics nurse specialists, robotic technology specialists, and safety champions.

It is important to recognize the successes that are already taking place in the perioperative environment, according to Komal Bajaj, MD, MS-HPEd, from NYC Health + Hospitals/Jacobi in North Central Bronx.

QI historically has investigated the gaps in care, the errors, and other failures within patient care as a springboard toward innovation by using a root cause analysis as the foundation of investigation and improvement.

Rather than using a reactive approach, Dr. Bajaj said the OR of the future would be proactive about patient safety.

“How can we learn from the wondrous things that happen each and every day, such as the complex case that goes off without a hitch, to make care safer for the patients who come next?” she asked.

Along with her team, she started to implement a “success cause analysis,” which deploys root cause methodology to understand positive outcomes, noting the effective response to pediatric malignant hyperthermia. The perioperative team observed two key factors they believed contributed to the success: escalation numbers were prominently displayed, and that the team happened to participate in experiential, biannual simulation drills on responding to malignant hyperthermia.

“So, we took those two factors and hardwired into similar areas, and we’ve had several other areas that have required escalation that have leaned heavily on these factors to have a successful outcome,” Dr. Bajaj said. This is an effective reminder about the importance of multidisciplinary care teams and their innate ability to diffuse QI principles.

Breaking Barriers Project Connects Local, National QI Efforts

Both ends of the QI scale, from national to local, can affect one another, as evidenced by the ACS Commission on Cancer (CoC) Breaking Barriers project.

Breaking Barriers is a national project that identified and aimed to reduce “no-shows” to radiation therapy appointments by 20%, according to Laurie J. Kirstein, MD, FACS, Chair of the CoC, who said that it is “a model for how to do a large-scale QI program while overcoming local barriers to care and strengthening standards.”

She provided a detailed overview of the project, which, through bidirectional communication between CoC leadership and local cancer centers, sought to determine if barriers existed to patients showing for radiation appointments. 

She defined two sets of goals: The national goal was to create a scalable framework for identifying the most modifiable barriers, while the local goal was to decrease no-shows of patients in active treatment.

Using the Breaking Barriers Toolkit, current results from the project have shown that participating programs “saw a 39.8% reduction in no-show appointments, 1,600 additional patients completing optimal radiation therapy, and improvements across all program types,” according to Anthony D. Yang, MD, MS, FACS, from Indiana University in Indianapolis.

To provide a local perspective, Camille Biggins, MHA, from the Floyd and Dolores Jones Cancer Institute in Seattle, Washington, described how her institution focused on transportation as the most actionable barrier that could be addressed with available resources.

During their root cause analysis, though, the QI team made the surprising finding that no-shows due to transportation barriers seemed to be decreasing. Was that barrier not as impactful as previously thought?

The answer revealed that local barriers are often highly contextual and dynamic. Transportation needs may change over the course of treatment, the accessibility of roads may change day to day, and even severe weather can affect access to transportation, Biggins said.

Social workers were spending a disproportionate amount of time absorbing the variations to prevent no-shows from occurring, masking the true magnitude of the barriers in the no-show rates.

“From participating in the Breaking Barriers project, we learned that no-show rates may mask the true extent of patient susceptibility to a given barrier; therefore, it is important to consider transportation vulnerability of each patient, even those who do show up for appointments,” she said.

Save the Date

Starting next year, the ACS Cancer Programs Annual Conference will be fully integrated into QSC to allow a larger platform for the latest in cancer QI and standards. The 2026 Quality, Safety & Cancer Conference will take place July 30–August 2 in Orlando, Florida.

Top 10 Abstracts

More than 800 abstracts were submitted for consideration at QSC, and the top 10 were featured in a General Session with brief presentations.

• Acute Care Surgery Pilot Program: OR Prioritization Protocol Decreases Healthcare Resource Utilization for Patients with Chole cystitis (EGS)
  Chad Hall, MD, FACS, Baylor Scott & White Medical Center, Temple, TX
• AI Capability in Patient Education and Pre-/Postoperative Care in Traceostomy (Education)
  Keer Zhang, PhD, Princeton University, NJ
• Creation of Data Dictionary to Standardize SCR Workflow and Data Entry (Pediatric)
  Megan V. Vitullo, RN, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, OH
• Day of Surgery Cancellations (Interdisciplinary Collaboration in Surgery)
  Norman Honecker, MBA, RN, CNOR, Cincinnati Children’s Hospital Medical Center, OH
• From Sterile to Sustainable: Implementing Tap Water for Endoscopy to Reduce Environmental and Financial 
  Costs (Environmental Sustainability in Surgery)
  Hilalion San Ahn, MD, University of Ottawa, ON
• Patient Valuation of Their Surgical Operations: Proof of Concept (Healthcare Information for Quality)
  Prakash Vasanthakumar, University of South Florida Morsani College of Medicine, Tampa
• Decreasing LOS for Hip/Knee Patients Arthroplasty at Safety Net Hospital by Using Lean Principles (Patient Reported Outcomes/Patient Centeredness)
  Colm D. Seigne, Sinai Health System Chicago, IL
• Reducing NSQIP Surgical Site Infections by Focusing on General Surgery: Topical Skin Adhesive Education and Patient After Care Instruction Standardization (Surgical Infection Control)
  Kyle V. Wong, Kaiser Permanente, Santa Clara, CA
• Risk Factors for Development of New Onset Anxiety and Depression after Anterior Cruciate Ligament Reconstruction (Surgical Potpourri)
  Justin J. Turcotte, PhD, MBA, Luminis Health, Annapolis, MD
• Utility of Triaging the Found Down Patient Population as Part of the New Field Trauma Triage Guidelines (Trauma/Acute Care)
  Sarah E. Johnson, DHSc, MS, ROT, Grand Strand Medical Center, Myrtle Beach, SC

Matthew Fox is the Digital Managing Editor in the ACS Division of Integrated Communications in Chicago, IL.