American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

ACS and San Diego Health Care Leaders Host Forum

Surgeons promote better patient outcomes and greater access to care at a lower cost


CHICAGO (March 8, 2012): More than 100 California health care leaders joined together March 2 for the American College of Surgeons (ACS) fourth Surgical Health Care Quality Forum at Scripps Memorial Hospital in La Jolla, CA. The session was held in partnership with community health care leaders representing Scripps Health; Naval Medical Center, San Diego; University of California, San Diego; and Kaiser Permanente. A. Brent Eastman, MD, FACS, Chief Medical Officer and Corporate Senior Vice President, Scripps Health, and ACS President-Elect hosted the community forum and introduced keynote speaker, David B. Hoyt, MD, FACS, ACS Executive Director, who set the tone of the discussion by summarizing how improving quality of care translates into better outcomes and greater access for patients at a lower cost.

“The ACS has something to bring to the table to lower costs and increase quality based on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®), which many hospitals in San Diego are already participating [in],” said Dr. Hoyt. “One of the things we hope these forums will do is bring together the community to focus in a more collaborative way on sharing ACS NSQIP data and finding solutions to common problems to improve quality. San Diego County has been an incredible leader in this regard with the development of its trauma system over 30 years ago that has since become a prototype for these quality improvement collaboratives.”

The ACS Surgical Health Care Quality Forum in San Diego is part of the College’s Inspiring Quality initiative to promote critical elements required in successful quality improvement programs to measurably improve outcomes while reducing health care costs.

“We all recognize our country is facing a broken health care system where costs are skyrocketing out of control,” said Dr. Eastman. “As health care providers, we are committed to helping solve this problem. The good news is the evidence-based and proven value proposition that says, by improving quality we can decrease costs and decrease variation in care, really can make a difference in working toward a sustainable health care system.”

Known as a model for outcomes-based quality improvement, ACS NSQIP collects clinical, risk-adjusted, 30-day outcomes data in a nationally benchmarked database. The program has been credited as “Best in the Nation” by the Institute of Medicine, and is currently utilized by approximately 400 hospitals across the U.S. A study published in the Annals of Surgery in 2009 determined that hospitals participating in ACS NSQIP prevented 250-500 complications, resulting in an average of 13-26 lives saved per hospital, per year. With the average cost of medical complications equaling $11,000 per occurrence, the combined potential savings of 4,500 hospitals could add up to $13-26 billion each year, amounting to an estimated total savings of $260 billion over a period of ten years.

Comments made by panelists during the community forum, included:

  • Chris Van Gorder, FACHE, President and Chief Executive Officer, Scripps Health; Immediate Past Chairman, American College of Healthcare Executives

    “Through eliminating non-value variation, we believe we can improve quality, reduce costs and create more value for our patients and for the organization. There are a lot of people who are saying ‘the sky is falling’ when it comes to health care. I have never been more bullish to say we are doing the right things and we’re moving in the right direction. I’ve never before seen this level of collaboration in over 30 years in health care – the doctors and administrators, all of us working together – we’re going to improve the health care system, create more value for patients and society.”
  • Mark A. Talamini, MD, FACS, Professor and Chairman, Department of Surgery, University of California, San Diego

    “In addition to creating the Quality Council at UC San Diego, implementing electronic health records, requiring crew resource management training for all surgeons and using data-driven quality improvement programs like ACS NSQIP, we’ve invested a large amount in a state-of-the-art medical training center at UCSD. Surgery is changing every day, so having a new high-tech training center where surgeons can come, relearn procedures and hone in their skills is a critical part of our surgical quality improvement initiatives.”
  • Captain Mark A. Kobelja, MD, MC USN, Deputy Commander, Naval Medical Center San Diego

    “All hospital systems are integrated because patients move around. Recognizing that the silos within the military system also exist in hospitals across the nation is one part of the quality improvement problem and we need to work at a leadership level within our organizations to systematically break down barriers. The ACS recognizes that quality improvement is not just about the surgeons; it’s about everyone involved in the care of the patient in a surgical environment. ACS NSQIP is an important program because it’s outcomes-based and focuses on ‘how did the patient actually do?’ which is powerful information to have to improve quality.”
  • Ralph Dilley, MD, Vice Chairman, Department of Surgery, Scripps Clinic Medical Group; Surgeon-in-Chief, Scripps Green Hospital

    “We felt that ACS NSQIP represented the best type of an outcomes-based approach to quality improvement so we implemented it at Scripps Green six years ago and our initial reports looked good. But we decided to look closely at just one post-operative problem in great detail and see what we could improve. We choose to monitor urinary tract infections over two years and our rates fell from 1.7 percent to 0.6 percent – a remarkable reduction. It just takes a one percent drop in surgical complications to have a very significant increase in quality and reduction in costs.”
  • Mark Schumacher, MD, FACS, Physician Director of Hospital Surgical Services, Kaiser Permanente

    “Kaiser is a big supporter of ACS NSQIP as a powerful tool to be able to look at data, but ultimately the outcomes are dependent on the people that institute the processes that we’re trying to change. Therefore, in addition to outcomes-based data programs like ACS NSQIP, we started looking at changing our culture using a safety attitudes questionnaire that correlates well with clinical outcomes and found we had opportunities for improvement. We’ve made numerous strides already in the last year and have realized great changes in our culture that improve quality.”
  • David Chang, PhD, MPH, MBA, Director of Outcomes Research, Department of Surgery, University of California, San Diego School of Medicine

    “From a health policy perspective, quality improvement is an attempt at better organization. We really don’t have great systems organization in health care today with the exception of the trauma system created by folks like Dr. Hoyt and Dr. Eastman in San Diego decades ago. Programs like ACS NSQIP represent a unique and innovative attempt at greater organization. When we talk about quality improvement it’s about implementing systems and I think it’s time to push that message out to the policy world. We also need to communicate to society that there are objective ways to measure quality and learn how to empower patients in the quality improvement process.”
  • James E. LaBelle, MD, MBA, Corporate Vice President of Quality, Medical Management, and Physician Co-Management, Scripps Health

    “We’ve gone from a world where quality was once just a component within the hospital and now it’s really a part of the organization. Physician engagement is critical to improving quality, and systems that drive the measurement of outcomes rather than process are much more meaningful. Even with outcomes-based programs, it still requires physician and administration leadership to drive cultural change within the system. One of the core benefits of ACS NSQIP is that it fosters deep conversations that require this type of collaboration.”

To further encourage community-level health care leaders to share best practices on quality improvement, the American College of Surgeons will continue to host a series of community forums across the nation throughout 2012. To view the archived forum video and follow updates on upcoming tour locations, please visit or the College’s YouTube channel at

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About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 79,000 members and is the largest organization of surgeons in the world. For more information, visit


Sally Garneski
American College of Surgeons

Stacey Rammer
Weber Shandwick