an environment where doing what is best for the patient
takes precedence over all else and where providers are
held accountable for the care they deliver but are treated
fairly and encouraged to learn from mistakes.
•High-reliability organizations (HROs). The manual
describes the characteristics of HROs and the change
management and performance improvement techniques
that lead to improved quality and safety.
•The unique qualities of the surgical disciplines. The
manual provides a brief overview of the resources,
training requirements, and regulatory mandates that
are specific to 20 surgical disciplines.
•Regulatory requirements. The rules and regulations
that affect all of surgery are reviewed, including evolving Medicare payment policies, federal and state agency
mandates, and standards issued by our own accrediting bodies, such as the American Board of Surgery and
the specialty boards, The Joint Commission, the ACS
Committee on Trauma, the Commission on Cancer,
and so on.
•Data analytics. Because data provide the basis necessary
to assess quality, two chapters focus on data collection
and analysis. One chapter describes the range of databases and sophisticated risk-adjustment techniques that
are available to help surgeons make evidence-based decisions. The second chapter explains how institutions can
put the data to work to produce better outcomes.
•Quality collaboratives. To help rationalize the investment in databases and to improve quality across regions,
a number of quality improvement collaboratives have
been established throughout the country. These partnerships allow institutions or individuals to benchmark
their performance against each other and to share their
•Clinical practice guidelines. Clinical practice guide-
lines based on the best available evidence are being
promulgated with some rapidity. These guidelines offer
a standard of care, but should be adjusted to meet the
specific needs of each patient and the environment in
which the care is delivered.
• Education and training. Most clinicians are only as good
as their education and training. Given the proliferation of
new technology and techniques, all of us must commit
to lifelong learning and continuing professional development. The manual summarizes the resources that
are available to help surgeons at all stages of their career
assess and improve their skills and knowledge.
The last section of this manual focuses more on
the “soft skills” that influence our ability to provide
optimal patient care. Specifically, it includes a discussion of the surgeon’s individual responsibility to the
patient, colleagues, and the next generation of surgeons. The process of surgeon improvement, problems
with disruptive behavior and how to address it, and
the importance of mentoring and coaching also are
An ongoing journey
Some surgeons may feel overwhelmed by the increasing expectation that they not only provide excellent
care but that they prove they do it as well. The College is committed to helping to ease these burdens
through its Quality Programs, and individuals who
attend the Quality and Safety Conference and who
make use of resources like Optimal Resources for Surgical Quality and Safety will find the road to better
outcomes a little less bumpy. ♦
Some surgeons may feel overwhelmed by the increasing
expectation that they not only provide excellent care but that
they prove they do it as well. The College is committed to
helping to ease these burdens through its Quality Programs.
If you have comments or suggestions about this or other issues, please
send them to Dr. Hoyt at email@example.com.