New College resource helps surgeons take 
the lead in quality improvement efforts

“The American College of Surgeons (ACS) motto is that we are ‘dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment,’” said David B. Hoyt, MD, FACS, ACS Executive Director, Wednesday during a Theatre Session on a new College resource, Optimal Resources for Surgical Quality and Safety.

Like other ACS programs aimed at helping the College to fulfill its mission, this manual promotes four principles of quality improvement: set the standards, build out the infrastructure, measure the data, and use external review to “assure the public that you’re doing what you say you’re doing,” said Dr. Hoyt, Editor of Optimal Resources for Surgical Quality and Safety.

“The purpose of this manual is to give you as a surgical leader a tool kit to create and apply a quality program,” Dr. Hoyt said. He explained how the book is laid out and what the purpose of each chapter is, noting that the manual starts by defining the five phases of surgical care—preoperative evaluation, immediate preoperative, intraoperative, postoperative, and postdischarge—offering about 50 specific recommendations about what should occur in each stage to ensure quality and safety.

The manual describes the role of the Surgical Quality Officer, which may be the chief of surgery, a medical quality officer, or another person with the authority and expertise to guide a quality improvement program, Dr. Hoyt said. The manual provides details about the role and relevance of peer review and case review, the surgical quality and safety committee, the requirements for privileging and credentialing, high-reliability, and how to create a quality- and safety-centered culture.

The manual also looks at the role of clinical practice guidelines, quality collaboratives, as well as data analytics as pathways to quality improvement, Dr. Hoyt said, and emphasizes the role and responsibilities of the individual surgeon.

“This is a start; it’s not the end,” Dr. Hoyt said. “The major purpose of this initiative is for the College to provide the leadership that you can then take into your hospitals to help improve the environment in which we treat our patients.”

“When we were writing this, and this has taken the better part of four years to do, we wanted to make this a manual. We didn’t want to make it another textbook, but a how-to manual,” said Clifford Y. Ko, MD, MS, MSHS, FACS, Director, ACS Division of Research and Optimal Patient Care, and Editor of Optimal Resources for Surgical Quality and Safety. “We wanted it to tell you what to do, what not to do, and make it very, very simple.”

The 135 contributing authors and editors of the manual sought to prevent it from becoming overly prescriptive, underscoring that different hospitals have different ways of achieving quality care, Dr. Ko said. They also considered who the audience would be for the manual and sought to align the information with the needs of surgeons and other surgical professionals, as well as the C-suite.

“We also asked ourselves, ‘Are these things that are actually going to help the patient?’” Dr. Ko said.

ACS Past-President J. David Richardson, MD, FACS, who is leading the effort to develop standards based upon the concepts outlined in the manual, put the resource and the potential standards into perspective given the current demands for value-based care. Dr. Richardson noted that while he doesn’t like anything that adds more regulation to the practice of surgery, he also realizes that “this quality movement isn’t going to go away.” According to Dr. Richardson, “If you don’t own quality, it may own you.”

The College’s leadership in developing the quality manual and standards for hospitals to ensure the provision of highly reliable care is “an opportunity for surgeons to take back what we own,” Dr. Richardson said. “This is a way to take ownership of quality.”