Ko: Working to improve quality care for patients

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Patients across the country deserve the best possible care outcome, no matter where they live

Current national strategies intended to improve the quality of patient care have led to the unwarranted variations in effectiveness, efficiency, and safety we see today. While some successes have been reported, we often see mediocre care at best. But it is not for a lack of trying. Hospitals and healthcare systems are dedicating large resources, efforts, and energy towards achieving better quality. Yet, despite best intentions, our healthcare system is failing to achieve the kind of quality we want for our patients, and the type of care patients want for themselves. We need to do better.

The good news is that over the last 25 years we have been quietly developing, learning, and successfully implementing a reproducible model for achieving high quality in surgery. We have learned from over 2,500 hospital implementations and believe now is an appropriate time to share our model with others in the healthcare landscape who are also striving to achieve better quality and outcomes.

The keys to our quality model are multifold; first, setting standards that span the care continuum while simultaneously aligning the multidisciplinary team of providers. The standards are evidence-based and focus on an inclusive programmatic view of care, including program-based staffing, requisite resources, and clinical processes. Together they produce an integration that has led to higher safety, efficiency, and effectiveness. Secondly, the model incorporates data to continuously inform and expectedly course correct to further improve the delivered care – thus supporting a true learning healthcare environment. Finally, to provide a level of assurance to patients, and all stakeholders, we have a streamlined verification process that ensures care and providers are meeting these evidenced standards.

This relatively simple yet comprehensive model has produced a sustained level of better results even if care is multi-sited (e.g., inpatient and outpatient) and complex. We share three examples. For decades, trauma centers have been going through processes to prove that they abide by a specific set of standards and have the resources and processes in place to provide quality care and improve outcomes for patients. These standards and resources allow doctors and care teams to react quickly and confidently in these highly complex, high acuity, and urgent situations. According to clinical data published in the New England Journal of Medicine, patients are 20% less likely to die in a trauma center than a non-trauma center, and patients with highest injury severity score are 30% less likely to die.

Similarly, it is crucial that the diagnosis and treatment for a person with breast cancer is correct and the National Accreditation Program for Breast Centers (NAPBC) has been publishing a set of standards for almost 20 years for treating patients with breast cancer. Breast cancer care is multisite, multidisciplinary, and multitherapeutic, adding variables that could cause delays, complications, and a lack of best-in-class care at different stages of the process. Data shows that the diagnosis and treatment of breast cancer performed 20-50% better in centers that are accredited than centers that are not accredited, showing how these standards can reduce inefficiencies in the overall process for a patient.

And a decade ago, bariatric surgery was not safe. The mortality rate for this elective surgery was 7% until the bariatric surgeons of the American Society for Metabolic and Bariatric Surgery (ASMBS) developed programs that have improved the outcomes of these surgeries. Despite treating a high-risk population, bariatric surgery is now one of the safest surgical operations in the U.S.

Why have we not shared this model previously? We probably should have, but hindsight is 20/20. The strategy two decades ago to use formally endorsed quality metrics across healthcare seemed reasonable at the time. However, problems with this strategy have arisen including unwanted variations in quality and escalating costs reported to be in the neighborhood of $5 million. Notably, the current quality system is also leading to provider burnout. This is not what we envisioned. We need a better strategy.

Why share now? Because we believe we have a strategy that could substantially help the quality problem in the U.S system. It has already worked across different diseases (e.g., malignant/benign, emergent/urgent/elective) and a spectrum of settings (e.g., rural/urban, small/medium/large hospitals, teaching/nonteaching). It builds on lessons from implementation in 2,500 hospitals/systems, and moreover, addresses shortcomings seen in our current quality strategies.

At the end of the day, if we can scale proven approaches to achieving high-quality care and outcomes, we can save lives, improve efficiency, and reduce costs. And while some hospitals have already prioritized quality using these programs, perhaps it’s time that more hospitals do so. Many hospitals do not know how they are doing or how many false negatives are leading to missed problems. This is why, in an effort to help hospitals, the ACS has launched a national, multi-year effort called the Power of Quality Campaign. ACS Quality Programs offer a roadmap for an entire care team to achieve high-quality and reduce variability. Implementing programs based on high standards give our hospitals the guidance they need to focus on real improvement.

Quality improvement is an ongoing journey and requires commitment and perseverance because it is hard work. If we together continue to improve standards of care in every hospital in America and build real quality and value, we can ensure all patients will have access to the high-quality care they deserve.

Clifford Y. Ko, MD, MS, MSHS, FACS, FASCRS, is Director of the Division of Research and Optimal Patient Care at the American College of Surgeons

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