Making quality stick: Optimal Resources for Surgical Quality and Safety: Beginning your quality improvement journey

Editor’s note: In July 2017, the American College of Surgeons (ACS) released Optimal Resources for Surgical Quality and Safety—a new manual that is intended to serve as a trusted resource for surgical leaders seeking to improve patient care in their institutions and make quality stick. Since September 2017, the Bulletin has highlighted some of the salient points made throughout the “red book.” This final entry offers an overview of the topics discussed in the manual.

Optimal Resources for Surgical Quality and SafetyThe red book defines the elements that are essential to ensuring the delivery of safe, reliable, quality care. Topics discussed include the scope of the surgeon’s responsibility in the five stages of surgical care, including the preoperative evaluation and preparation, immediate preoperative readiness, intraoperative, postoperative, and postdischarge phases. Also covered are the need for leadership, peer review and case review processes, the committee structure necessary to effect change, and credentialing and privileging.

A central focus of the red book is on creating a culture in which quality improvement and patient safety are valued. Such a culture emphasizes fairness, accountability, and honest discussion of problems as they arise. It incorporates the principles of change management and performance improvement that have been successfully adopted in other high-risk professions.

Because each surgical specialty and subspecialty requires different resources, different training, and compliance with different regulatory mandates, the next portion of the book looks at each of these areas by discipline. Regulatory policies that affect all specialties also are discussed.

Accurate data collection and analysis form the backbone of all quality improvement efforts. The red book provides a summary of the clinical registries available to help surgeons and institutions determine where they need to improve their performance.

To encourage cost-effectiveness and accurate benchmarking of outcomes, many institutions now participate in quality improvement collaboratives. Leaders of several of these partnerships describe how they were started and how the members have worked together to drive the provision of value-based care. From data analysis performed collaboratively, a number of coalitions and organizations have produced reliable clinical practice guidelines.

Education and training are paramount to the provision of quality care. The techniques for providing surgeons at all stages of their career with the skills and knowledge they need to provide reliable care are summarized.

The manual closes with a discussion of the individual surgeon’s responsibility to the patient, colleagues, and the next generation of surgeons. Topics discussed include retooling, the effects of disruptive behavior, and the impact of mentors and coaches.

As some users have said, the red book points surgeons to the resources, tools, and skills that are essential to providing patients with optimal care. It is the road map surgeons and their institutions will refer to again and again on their journey to quality improvement.

Optimal Resources for Surgical Quality and Safety is available for $44.95 per copy for orders of nine copies or fewer and $39.95 for orders of 10 or more copies on the ACS website.

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