Today, the American College of Surgeons (ACS) released a limited-edition book, Inspiring Quality Tour: Lessons Learned in the Pursuit of Quality Surgical Health Care, in conjunction with its annual Leadership and Advocacy Summit in Washington, DC. Lessons Learned summarizes the findings of an 18-month effort by ACS to create a national dialogue about surgical quality and patient safety through a series of ACS Surgical Health Care Quality Forums around the country. Hard copies of the book will be made available to ACS members and policymakers, and it is also available for download at http://www.facs.org/quality/lessonslearned.html(.)
Starting in July 2011, ACS organized 11 regional forums in key states, convening panels composed of surgeons, hospital administrators, policymakers, nonsurgeon members of the surgical care team, health policy analysts, and other stakeholders. A total of 95 panelists spoke from varying perspectives about their concerns, experiences, success stories, and challenges in responding to the two great pressures the U.S. health care system faces today—improving quality and reducing costs.
The forums were a vital piece of a larger campaign, “Inspiring Quality,” which ACS launched two years ago to raise awareness of proven models of quality improvement that can help improve both the quality and value of health care. Since the Institute of Medicine issued its influential report “Crossing the Quality Chasm” 12 years ago, many quality improvement initiatives have been started taking on the problem from various perspectives, but health care quality remains uneven.
“The College has 100 years of experience developing rigorous quality improvement and educational programs,” said David B. Hoyt, MD, FACS, ACS Executive Director. “Surgeons have a responsibility to share what we’ve learned with the larger health care community and Congress and collaborate with them to achieve our shared goal of continuously improving the quality of surgical care.”
Nonsurgeons, including Stuart Altman, PhD, MA, BBA, the Sol C. Chaikin Professor of National Health Policy at the Heller School for Social Policy and Management, Brandeis University, agree. In a quote from the book taken from his keynote address at the Boston forum in June 2012, Altman said, “In the past we didn’t include physicians and surgeons in discussions on how to fix the American health care system because we thought they were part of the problem—a big mistake. We need them as part of the solution because they are American health care.”
From all the presentations at the 11 regional forums, six overarching lessons stood out as keys to continuous quality improvement:
1. Quality improvement is the future of medicine. Cost reduction through higher-quality care, greater emphasis on evidence-based medicine, and reducing variation in how care is provided are all vital to providing Americans with high-quality, affordable care. For example, multiple studies on the ACS National Surgical Quality Improvement Program (ACS NSQIP) have confirmed the cost savings that result from reducing the rate of surgical complications and improving quality of care.
2. Quality is measurable. The saying that “what gets measured, gets done,” holds true in health care. Even high-performing hospitals can move the rate of certain complications toward zero by focusing on their results, measuring in the right way, and targeting poorer outcomes and emerging trouble spots.
3. High-quality data is essential for quality improvement. Hospitals today have a range of tools, including ACS registries and proprietary dashboards, to set quality targets, measure performance, and tackle areas of concern. Programs like ACS NSQIP offer risk-adjusted, verified, clinical data (not administrative data that many hospitals currently use) that hospitals can use to track their progress internally and benchmark against a national standard.
4. Quality thrives in a supportive culture. Team work and a culture in which every member of the hospital staff feels a sense of responsibility for patient safety and quality care are essential to sustained quality improvement.
5. Collaboration spurs innovation and higher quality. National partnerships and statewide hospital quality collaboratives are just two of the ways that health care organizations are banding together to share data and best practices in pursuit of higher-quality health care.
6. Surgeons must lead on quality: in the operating room, on Capitol Hill, and in the classroom. Policymakers, including U.S. Rep. Jim McDermott (D-WA), said they welcome surgeon input to their Congressional representatives about health care, including quality, cost, and their experiences with the Affordable Care Act. Surgeon leadership is also sought on a daily basis in the operating suite, in preparing the next generation of surgeons, and in keeping today’s surgeons current with ever-evolving technology and evidence-based techniques.
In addition to the lessons, the book provides background on the American College of Surgeons and its surgical quality and education programs, a summary of each forum with main points made by each speaker, and select case studies that point to successful models for improving health care quality.