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

From the Director's Desk

Next Generation Standards

Heidi Nelson, MD, FACSHeidi Nelson, MD, FACS
Medical Director, ACS Cancer Programs

Standards are foundational to the mission of the American College of Surgeons (ACS), and for nearly 100 years they have been the principle method used by the Commission on Cancer (CoC) to accredit hospitals and improve the care of the cancer patient. Standards have not been static; in fact, they have continuously moved with the times. For example, current-day standards are expected to be evidence based in the pre-implementation phase and validated for impact in the post-implementation phase. Case in point are the 2020 cancer surgery standards that are now being phased in and include the introduction of synoptic operative reports to evaluate compliance (see ACS Launches New Cancer Surgery Standards Program in this newsletter). Like the cancer surgery standards, most are selected to address a specific patient care need, or gap, and are increasingly the codification of best practices or guidelines. Without a doubt, standards have improved cancer care, and yet, one cannot help but wonder if they could do more. Could they, for example, simplify or reduce the work of the provider or provider teams? 

If we look outside of cancer, there are examples of standardization efforts, such as the Enhanced Recovery After Surgery (ERAS) pathways that have been implemented without accreditation mandates. The ERAS perioperative pathways are similar to CoC standards in that they are multidisciplinary, evidence-based, and have repeatedly been proven to improve patient outcomes. It has been a couple of decades since ERAS was introduced, but the program has caught on in most surgical practices despite the absence of support from an accrediting body.

Could standardization become more widely embraced if there were secondary benefits for providers? With ERAS, the day-to-day work of communication and coordination is reduced because team members and patients know their roles, responsibilities, and expectations. Perhaps for the next chapter, we could turn to the emerging field of implementation science and seek guidance on how future standards could benefit providers as well as patients to create next-generation standards that bring broader value to health care.