The American College of Surgeons (ACS) hosted nearly 80 health care and aviation industry leaders at its fifth Surgical Health Care Quality Forum on Wednesday, April 11, at The Rainier Club in Seattle, WA. The event brought together a diverse combination of leaders from Washington State's aviation and health care industries to champion effective quality improvement programs and best practices in checklists, standardization, culture shifts and transparency to make surgery safer and reduce health care costs.
Carlos A. Pellegrini, M.D., FACS, FRCSI (Hon.), The Henry N. Harkins Professor and Chair, Department of Surgery, University of Washington and past Chair, American College of Surgeons Board of Regents, hosted the event, which featured opening remarks from Congressman Jim McDermott (WA-7th District). The Congressman discussed the challenges of health care quality and cost, Washington State's leadership in quality improvement, and why it is important for the surgical community to be involved in health care discussions on Capitol Hill. "One of the greatest challenges we face in Congress is [health care] costs," said Congressman McDermott. "This is an opportunity to recognize the surgeons at the University of Washington and around the state who are applying the principles of quality and cost and proving these two things are not at odds with each other."
The Seattle forum, part of the College's Inspiring Quality initiative to drive national discussion around critical elements required in successful quality improvement programs, highlighted the adoption of aviation-like standardization and checklists, as well as quality research and data from programs like the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP@), the Surgical Care and Outcomes Assessment Program (SCOAP) and its research platform, CERTAIN.
"We thought it was very appropriate to unite the ACS Inspiring Quality initiative with aviation expertise and the successful quality programs we have implemented to date here in the state of Washington," said Dr. Pellegrini. "This was a unique opportunity to invite and learn from two industries that represent everything we are trying to achieve with Inspiring Quality: safety, quality and excellence."
ACS Executive Director David B. Hoyt, M.D., FACS expanded on the College's rich history driving quality improvement and stressed the important connection between quality and education."We have a responsibility to demonstrate to patients that our educational efforts are preparing us to provide the best quality care," said Dr. Hoyt. "The ACS Division of Education has developed an accreditation program across the country that includes 65 institutes where surgeons are being trained and new and existing procedures are being reaffirmed. This is a model for the future and is really about the public and patients trusting that we are qualified as surgeons to do a procedure."
The event also celebrated the launch of the new Strong for Surgery initiative - a partnership between CERTAIN and the Washington surgical community, the ACS Division of Education, the Agency for Healthcare Research and Quality (AHRQ), the Life Sciences Discovery Fund and Nestle HealthCare Nutrition - which will bring preoperative checklists and nutritional interventions to doctors' offices and engage patients as their own health care advocates to help further improve surgical outcomes.
"Strong for Surgery takes the idea of checklists and moves them to where decisions are mostly being made, before the patient gets to the hospital," said David Flum, M.D., MPH, FACS, Associate Chair for Research and Surgery and Professor, Surgery, Health Services, and Pharmacy, University of Washington. "There would never be an airplane that would start a checklist when it is already moving down the runway, and the same concept applies to surgery. The doctor's office is the last opportunity to have those important discussions about whether the patient is ready for an operation." Additional comments made by participants during the community forum, included:
-- Bradley D. Tilden, CEO-Elect, Alaska Air Group: "Safety is critical to both aviation and health care - both patients and customers place their lives in our hands. You have to be able to talk about mistakes, and it's important to make the culture safe for people to bring these things up so you can improve."
-- Keith W. Leverkuhn, Vice President of Engineering, General Manager, Propulsion Systems, Boeing Commercial Airplanes: "When it comes to cost of quality and assuring safe outcomes, there are probably more similarities than differences between aviation and surgery. The idea of standardization and innovation in conflict couldn't be further from the truth - they are absolutely interdependent. The challenges we face are how to take advantage of the tools to bring costs down and be sure that we don't stray away from the imperatives of standardization and innovation."
-- Thomas K. Varghese Jr., M.D., MS, FACS, Director, Thoracic Surgery Program, University of Washington, Harborview Medical Center: "The concept of the Strong for Surgery initiative is shifting the spotlight from the operating room to the doctor's office where the decision takes place - not only the decision for the operation, but how to make the patient stronger for the surgery and thereby improve the patient's safety and outcomes. When you start digging into it, nutritional impairment is the leading cause of complications and death in surgical patients, and all patients having surgery should be assessed for nutrition."
-- Ellen T. Farrokhi, M.D., FACS, Medical Director, SCOAP; Vascular Surgeon, Providence Regional Medical Center Everett: "I think SCOAP and CERTAIN are wonderful partners - they both benefit each other to advance the purpose of the College, to inspire quality, to make surgery safer and expand the checklist. They are patient-focused, and I'm confident this state will lead this effort for the nation."
-- Richard C. Thirlby, M.D., FACS, General Surgeon, Virginia Mason Medical Center: "The philosophy of patient safety at Virginia Mason is: mistakes are different than defects. People tend to focus on the bad outcomes, when it's really more bang for the buck if we focus relentlessly on mistakes that don't necessarily always result in errors or harm to the patient."
-- Scott R. Steele, M.D., FACS, FASCRS, Colon and Rectal Surgeon, Madigan Healthcare System; Assistant Professor of Surgery, Uniformed Services University of the Health Sciences and University of Washington: "One of the challenges that we have at Madigan is incorporating quality into practice. We involve our residents in quality improvement at a hospital service level, and as part of their research program they look at ACS NSQIP data in a certain area and figure out how to apply what the data says back to patient care. Hopefully residents will see that the quality up front will lead to better patient outcomes at the back end."
-- Morris G. Johnson, M.D., FACS, General Surgeon, Skagit Regional Clinics; President, ACS Washington State Chapter: "An amazing thing happened at our hospital and it started with a simple conversation between me and our head of anesthesia. After looking at our SCOAP data, we realized we needed to do a better job of glucose management and post-operative protocols for diabetes. We pointed out to administration how much savings we would generate, and within exactly 120 days we got staffing levels improved, and increased the number of insulin pumps and glucose monitors on the floors and in the OR. It started with one person asking a question, but we all joined arms together and it's quite a remarkable accomplishment in a short period of time."
-- Richard P. Billingham, M.D., FACS, Colon and Rectal Surgeon, Swedish Medical Center: "We are now collecting data both on process and outcomes, but the culture change is going to have to come at the hospital, or care-giver level, where we determine standards of care and make sure that each of our hospitals are maintaining these current standards. It's expensive for hospitals to do this - when I first went into medical practice they said you have to spend money to make money, but now I think the mantra is you've got to spend money to save money. I'm hopeful that our colleagues at the hospital administration level understand the money they are spending on quality control is going to reap huge benefits both in patient care and in terms of bottom line."
To further encourage community-level health care leaders to share best practices on quality improvement, the ACS 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 InspiringQuality.FACS.org or the College's YouTube channel at http://www.youtube.com/AmCollegeofSurgeons.
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 care of the surgical patient. 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 78,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.