As the industry shifts to value-based reimbursement models, improving patient care is a business imperative as well as an ongoing clinical objective. Given the high volume of surgeries performed at the nation’s hospitals and ambulatory surgery centers, improving the quality and safety of surgical care is taking on added financial importance for providers.
A new manual from the (ACS) offers practical steps hospitals and ASCs can take to improve the quality and safety of surgical procedures and minimize the risk of harm to patients.
The following six recommendations are derived from the ACS’ handbook, Optimal Resources for Surgical Quality and Safety:
1. Adopt a patient-centered, physician-led and team-based surgical care model
Hospitals and ASCs should use a team-based care model at each of the five phases of a surgical episode of care: preoperative evaluation and preparation; immediate preoperative readiness; intraoperative; postoperative; and post-discharge. A team-based approach improves the quality and safety of a surgical episode of care by applying coordinated resources and expertise at each of the five phases. For example, during the preoperative evaluation and preparation phase, the multidisciplinary team works with the surgeon and the patient to determine whether surgery is appropriate for the patient. That includes reviewing surgical risk factors like the patient’s health, other medical conditions and medications.
2. Create the position of surgical quality officer to serve as an institutional champion
Hospitals and ASCs should create the position of surgical quality officer (SQO) to lead the effort to build and maintain the infrastructure, internal systems, clinical protocols and practice standards that promote optimal surgical care for patients. The job also includes making sure that all members of the surgical care team have the tools, resources, training and competencies they need to provide safe, high-quality care to surgery patients. The SQO should be proficient at using performance improvement, project management and quality improvement principles to drive surgical performance and be adept at using data to support those processes.
3. Restructure surgical case review and peer review as quality improvement forums
Rather than seeing case review and peer review as pro forma medical staff activities, hospitals and ASCs should see them as dynamic opportunities to improve surgical care. Hospitals and ASCs should make the reviews comprehensive by conducting all five types:
- Single-discipline case review
- Multidisciplinary case review
- Peer review of individual surgeons
- Data/registry review
- Educational review conference
If any review identifies a problem, hospitals and ASCs should follow a four-step process to correct it and sustain surgical care performance: develop a solution to the problem; provide training in the processes needed to execute the solution; implement the solution; and measure continued performance.
4. Establish a robust internal surgical quality and safety committee
Like case review and peer review, most hospitals and ASCs have surgical quality and safety committees. What most lack, however, is a robust infrastructure to promote the delivery of high-quality, safe and reliable surgical care that can be sustained over time. The committee must have the resources, systems and staff to assume and execute 10 specific responsibilities, including:
- Overseeing surgical mortality and adverse event rates
- Addressing and resolving surgical practice variations
- Establishing quality and safety standards, guidelines and policies
- Monitoring data and reports to identify surgical issues
- Developing, aligning and implementing corrective action plans
5. Build a surgical culture focused on quality, safety and high reliability
Creating a culture of patient safety within a provider organization has long been recognized as one of the most effective ways of improving patient safety. Common barriers to a true culture of patient safety at a hospital or ASC include: long-established hierarchies; divisions, departments and disciplines that operate in silos; and accepted deviances from standardized practices. With surgeons often at the top of the hierarchies, it’s up to them to effect change. Change starts with seeing the hospital or ASC as a high-reliability organization (HRO) and adopting five characteristics that define an HRO:
- Preoccupation with failure
- Sensitivity to operations
- Reluctance to simplify interpretations
- Commitment to resilience
- Deference to expertise
6. Excel at using data to monitor and drive improvements in surgical quality and safety
The ACS manual focuses on how data makes all the other strategies and tactics outlined in the book possible. The ability of a hospital or ASC to collect, analyze, report and act on clinical outcome and cost data is essential to improving the quality and safety of surgical care. Hospitals and ASCs should not limit analytics to their own databases of surgical information. They should access or partner with regional and national databases of surgical information in order to compare their clinical and cost outcomes with peers across the country. Analytical tools should include the ability to perform risk-adjusted evaluations of surgical outcome data and to benchmark performance. The results can be fed into the continuous performance-improvement processes of the surgical care team, the SQO, case and peer review, and the quality and safety committee to create a sustainable culture of patient safety.
Hospitals and ASCs that pursue the six strategies and tactics will be able to create more healthcare value by making surgical care better and safer for patients.