Disclosures No financial conflicts of interest 2013 Naffziger Lecture Officer of the American College of Surgeons Founding member of one of organizations I will discuss today Carlos A. Pellegrini MD FACS The Henry N. Harkins Professor and Chair Department of Surgery University of Washington Defining leadership Leadership is a combination of a meaningful vision with the ability to The Surgeon as a Leader: Improving influence others by non-coercive Quality, Decreasing Costs means. Leadership is personal and is exercised using values and styles that must fit Leadership the circumstances (time, environment, etc.) Quality Costs 1
“End Results” – The Vision Ernest Amory Codman, MD Surgeon’s role in leadership as it relates to Quality of Care IS THIS A NEW CONCEPT? "We believe it is the duty of every hospital to establish a follow-up system, so that as far as possible the result of every case will be available at all times for investigation by members of the staff, the trustees, or administration, or by other authorized investigators or statisticians." 5/17/2013 6 Quack Medicine - Then Codman’s Books – Reprinted The Hype: Reality: CNS Disorders Compromised Organ function Vitamin Deficiency Headaches Diarrhea & Abdominal Pain 5/17/2013 5/17/2013 7 8 2
Dubious Hair Growth Products “There is a special place for people who complain about the healthcare system but do nothing to change it….it’s called the doctors’ lounge” The Hype: “Discover the All-Natural Formula that’s Clinically Proven to Help You Retain and Regrow Your Hair. If you are a man concerned about stopping hair loss, Our Product (Procerin) can help. It comes in a convenient tablet form and topical solution that are used daily for the treatment of male hair loss. It is an all-natural supplement available without a prescription. And, it has no side effects.” 5/17/2013 9 Taking on the “challenge” 1. QUALITY DEFINED 3
Quality in Medicine Quality in Medicine - Care The provision of care that is safe, SAFE – primum non-nocere effective, efficient, timely and EFFECTIVE – Evidence-based EFFICIENT – No waste patient centered for all those TIMELY – who are in need. PATIENT CENTERED – preferences and values UNIVERSAL – Reduce disparity Crossing the Quality Chasm: A New Health System for the 21st Century Crossing the Quality Chasm: A New Health System for the 21st Century The Next Era of Quality Redefining Health Care: Creating Value-Based Competition on Results Michael Porter, PhD The relationship of Quality to Costs - Elizabeth Olmsted Teisberg, PhD COSTS 4
The Value Equation in Healthcare The Goal of Value: To Guide Everyone’s Choices The Value Compass Value = Health Care Outcomes VALUE Dollars Spent 1 1 5/17/2013 5/17/2013 7 8 Bulletin of the ACS May 2013 5
Value Based Care National Tour Collecting health care leadership insights, best-practices and case studies from each tour stop to develop…. 18 Exercising Leadership in QI Identify practical opportunities for individual surgeons in the areas of � Training � Certification � Participation in National Programs of Quality � Creation of Regional Programs Regardless of whether you � Creation of Local Programs The idea is how can � Teamwork Work in an Academic or You participate and In a Private environment Become a leader….. 6
Do not just “teach” – use training Focus on the importance of Quality Make Students-Residents-Fellows participate actively in safety and quality Drive into them the notion of constant change Facing the challenge Create the ability to define “gaps” TRAINING Train to proficiency/competency/expertise Training and Education of Residents Ability/ Knowledge dexterity Values and PROFESSIONAL Aptitudes DEVELOPMENT /MOC 7
Challenge yourself….. Introduction of new technology � Is it for you? � Is it in your field? A professional organization � Does meet “quality” criteria? meets the Challenge � Is it a gimmick? 4. THE ACS NSQIP Maintenance of Certification ( NATIONAL SURGICAL QUALITY � Use the process to your advantage IMPROVEMENT PROGRAM) Program Overview Quality Improvement Process 1. Hospitals abstract data. • ACS NSQIP is a data-driven, 2. Data are analyzed by ACS NSQIP . risk-adjusted, outcomes-based surgical quality improvement 3. Data are reported back to hospitals. program. 4. Targets for improvement are identified 5.Hospitals act on their data. 6. Hospitals monitor interventions with data. 8
Interpretation of Results Interpretation of Results Observed to Expected (O/E) Ratio Over-Time Performance • Hospital’s outcomes compared to the other ACS-NSQIP hospitals, • Represents the hospital’s previous O/E ratios from the 10 most adjusted for inter-hospital differences in patients’ characteristics, recent semi-annual reports comorbidities, and preoperative laboratory values Overall (Multispecialty) 30-Day Morbidity O/E Ratios Low Outlier Overall (Multispecialty) 30-Day Morbidity O/E Ratios High Outlier Low Outlier O/E LOW OUTLIER : If the upper bound of the O/E confidence As Expected 1/1/2007 - 12/31/2007 99% Confidence interval High Outlier O/E Ratio 1/1/2007 - 12/31/2007 interval is <1.0, the hospital’s outcomes are statistically 99% Confidence interval High Outlier Ratio 2 Current O/E Ratio better than expected. Thus, the hospital’s outcomes are 2 “Exemplary.” Low Outlier 1 1 AS EXPECTED 0 HIGH OUTLIER : If the lower bound of the O/E ratio is 0 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 9999 >1.0, the hospital’s outcomes are statistically worse than expected. Thus, the hospital’s outcomes “Need ACS NSQIP Hospital ID Number Report Identification Number ACS NSQIP Hospital ID Number Report Identification Number Improvement.” General Surgery 30-DayMortality General Surgery30-Day Morbidity Observed Rate: 0.91% Observed Rate: 12.01% Expected Rate: 11.32% Expected Rate: 1.04% O/E Ratio: 1.06 O/E Ratio: 0.88 Status: As Expected Status: As Expected 9
General Surgery: Cardiac Complications General Surgery: Pneumonia Observed Rate: 0.17% Observed Rate: 0.91% Expected Rate: 0.4% Expected Rate: 1.44% O/E Ratio: 0.41 O/E Ratio: 0.63 Status: As Expected Status: As Expected General Surgery: Unplanned Intubation General Surgery:Ventilator >48 Hours Observed Rate: 2.15% Observed Rate: 2.49% Expected Rate: 1.28% Expected Rate: 1.62% O/E Ratio: 1.68 O/E Ratio: 1.54 Status: Needs Status: Needs Improvement Improvement 10
General Surgery: DVT/PE 118 Hospitals in NSQIP 2005-2007 Reduced Observed Rate: 1.24% Complications Expected Rate: 0.99% O/E Ratio: 1.26 Reduced Status: As Expected Disparities of Care Improved Overall Quality Ann Surg 2009 Washington State initiatives to improve surgical outcomes Creation of Regional Programs Focus in process and outcomes Led by Surgeons SURGICAL CARE AND OUTCOMES PROGRAM (SCOAP) 11
What is SCOAP? What does SCOAP provide? • Washington State program targeting quality and A surgeon-led collaborative using a data driven cost-effectiveness quality surveillance and response system to • Clinicians define metrics and hospitals track them deliver more appropriate, safer and higher • Improve through benchmarking and intervention quality surgical care across the Pacific Northwest � SCOAP Reports How does it work? � SCOAP Regional meetings � SCOAP Box newsletters � Surveillance of surgical process and outcome metrics � SCOAP Interventions � Compares to other hospitals and to benchmarks � SCOAP ROI � Focused on a given operation � Created and monitored by surgeons Surgeons Get “Signal” How To Read A SCOAP Report SCOAP has 3 high-level signals Red=Metrics that are greater than one standard deviation away from SCOAP average Yellow=Metrics that do not reach the SCOAP average Green= Metrics that meet or exceed the benchmark performance rate Note: Metrics in gray are at least meeting the SCOAP average, but do not meet the benchmark rates 12
Who runs SCOAP? The Scope of SCOAP Administrative home Port Mt Vernon � Foundation for Healthcare Quality Angeles Port Research/creative home Seattle Townsend • Spokane � University of Washington Department of Surgery’s Wenatchee Surgical Outcomes Research Center (SORCE) Aberdeen Kirkland Tacoma Clinician-based advisory board Sunnyside Yakima Olympia Richland Funding Longview � Hospital pays abstractors and modest yearly fee Portland � Life Science Discovery Fund supported expansion Variability in Outcome Bile duct injury in Washington State 1987-2004 Variability in Processes of Care 3.50% and Outcomes in WA state 3.00% % CBD Injury 2.50% 2.00% SCOAP Data 1.50% 1.00% 0.50% 0.00% 0 5 10 15 20 25 30 35 40 Hospital 13
Variability in Process Colorectal Surgery Outcomes Use of Cholangiography in Washington State 25.00% 100.00% 20.00% 80.00% 15.00% % IOC 60.00% 10.00% 40.00% 5.00% 20.00% 0.00% 0.00% 90-day mortality 0 10 20 30 40 50 60 70 80 90 Hospital Colon Resection Reoperation Rate By Hospital, 1987-2004 Before SCOAP Variability 40.00% Time Trends 35.00% 30.00% 25.00% SCOAP Data 2006 - 2008 20.00% 15.00% 10.00% 5.00% 0.00% 0 10 20 30 40 50 60 70 80 90 100 14
Recommend
More recommend
