In my July 2017 “Looking forward” column, I wrote about the American College of Surgeons’ (ACS) newly released publication, Optimal Resources for Surgical Quality and Safety, also known as the “red book.”* Although it is only six months later, I want to share some further reflections on what the publication represents, not only for the authors but increasingly for those who have read it and have shared their feedback with us.
As most of you know, quality improvement in surgical care has been the cornerstone of the College’s efforts since the organization’s inception more than 104 years ago. Since then, the ACS has been the standard bearer of quality in surgery. The Inspiring Quality program that the College launched in 2011 succeeded in informing surgeons, policymakers, and members of the public about the College’s ongoing commitment to quality and safety through the use of our four-point model of setting the standards, creating the infrastructure, using the right data, and verifying that these protocols are being met through external review. As we had anticipated, our four-point model has been embraced by many surgeons and organizations subsequently.
The red book
But inspiring surgeons to provide quality care was not enough. Was there a way the College could assure surgeons they were prepared to provide quality surgical care? It was five years in the making, but the red book conveys the wisdom and experience of 135 thought leaders in quality and safety in surgical care.
We began this endeavor at a time when many surgeons were becoming frustrated with increasing regulatory and administrative demands. Many surgeons felt that they were losing their autonomy, authority, and authenticity to regulators, administrators, payors, and other stakeholders. We sought to demonstrate how surgeons not only can comply with these evolving demands, but can and should retain their ability to self-regulate and lead the patient care team.
Optimal Resources for Surgical Quality and Safety functions as a true manual in the sense that it provides a detailed overview of the essential elements that any hospital or surgical practice should have in place to deliver safe, reliable, quality care, including a Surgical Quality Officer, peer review and case review processes, quality assurance committees, and credentialing and privileging protocols.
The red book discusses high-reliability and how to create a culture that fosters quality and safety through change management and performance improvement techniques. It looks at the tool sets that are available to surgeons and their institutions to provide the support they need as they traverse the road to quality improvement. It describes clinical databases and how to translate the data into better care. It explains how participation in quality collaboratives allows surgeons and their institutions to learn from each other about what works and what doesn’t. The manual demonstrates how this shared knowledge can lead to the development of clinical practice guidelines that are uniquely applicable to an individual provider’s patient population and practice setting.
It encourages lifelong learning and retooling of one’s skills, for without education there can be no quality. It describes how surgeons can use mentoring and coaching not only to train residents and young surgeons, but to help our colleagues address those areas of practice where they could perhaps use some guidance. It looks at the effects of burnout and disruptive behavior, explaining how surgeons can compassionately help their colleagues get back on track.
Most importantly, Optimal Resources for Surgical Quality and Safety begins and ends with an emphasis on the roles and responsibilities of the individual surgeon. Indeed, this message is underscored throughout the entire red book, emphasizing that it is the individual surgeon in whom each surgical patient places his or her trust and describing what surgeons can and should do to at each phase of care to ensure that confidence is earned, established, and maintained.
Other specialty societies recognize the value of this resource and are now working with the College to develop quality programs for vascular, thoracic, cancer, geriatric, emergency and critical care, and rural providers. We anticipate that as more groups develop these resources, more patients will receive optimal care.
Your passion for quality
We know that each of you feels as passionately about the provision of quality care as the authors of Optimal Resources for Surgical Quality and Safety. During Clinical Congress 2017, our consultants with Weber Shandwick, Minneapolis, MN, interviewed both longstanding and newer members of the ACS to identify how they define quality. As the interviewees spoke, their passion for the topic became evident. We anticipate that the red book and the set of standards that will evolve from it will provide the resources and protocols that surgeons can use to channel their deeply held beliefs into positive action.
The ACS leadership believes that the College’s members are strongly positioned to become fierce advocates for quality improvement and high reliability within their institutions. They can inspire both the administrative and clinical leaders of their hospitals and practices to create a culture where quality care translates into better outcomes and value-based care. They can lead and mentor young surgeons in the provision of safe care from the time of initial consultation through postdischarge. They can use ACS Quality Programs and other sources of outcomes data to determine where there is room for improvement and collaborate with other providers to develop best practices and clinical practice guidelines. They can encourage one another to commit to maintaining the skills and knowledge they need to provide optimal care and to helping their colleagues recognize when they may be engaging in behaviors that have a negative effect on the delivery of coordinated, team-based care. The red book will be a foundational resource that surgeons and other providers can use to initiate and advocate for all of these changes.
Our goal now is to help our members turn their passion toward ensuring that health care systems, health care executives, payors, and policymakers understand the principles of quality improvement and work with us to do what is right for the patient. I am sanguine about the possibilities for the future and urge you to stay tuned as we find new ways to help you protect the integrity of the profession and quality of patient care. It is through these actions that surgeons reaffirm what ACS President Barbara L. Bass, MD, FACS, FRCS(Hon), describes as “the joy and privilege of a surgical career.”
*Hoyt, DB. Looking forward. Bull Am Coll Surg. 2017;102(7):10-12.
If you have comments or suggestions about this or other issues, please send them to Dr. Hoyt at email@example.com.