Achieving quality improvement depends on the local culture

The key to sustaining quality outcomes is promoting confidence and engagement of surgical teams, says Clifford Ko, MD, MS, MSHS, FACS, director of the National Surgical Quality Improvement Program and Division of Research and Optimal Patient Care, at the American College of Surgeons in Chicago. Dr Ko gave the keynote address on Thursday, October 8, during the annual OR Manager Conference in Nashville, Tennessee.

Facilities that are very successful in their quality improvement initiatives have figured out how to engage their staff, but this could be totally different in the next hospital, says Dr Ko. “What we have found is that the quality principles are very general but achieving quality is local. The personnel are different, the resources are different, the teams are organized in different ways, and the culture is different,” he says. “The local piece is what is really important and we don’t appreciate that enough.”

Data tells us how we are doing

“All of us want to get better, but we don’t all know what it takes,” says Dr Ko. “The first lesson is to look at your data,” he says. “Without data, we think we are great, but with data we find out we are average. We have found that hospitals who own their data improve. Those who ignore their data don’t change.”

Standardization is key

Some hospitals improve faster than others and the reason is because some took longer to incorporate standardization into their practice, he says.

Though standardization is essential, something more is needed for success. That is innovation. Things happen between the times of standardization where improvement wanes. “When we ask what is happening, they say they are trying something new,” says Dr Ko. They innovate and try to do it a new way.

This is better than not standardizing at all, he says. “The difference between not thinking about it and just doing things ‘willy nilly’ versus standardizing and innovating is what continuous quality improvement really is all about.”

Culture is important

The way things get done and quality and safety are linked together because it is hard to improve quality and safety without a good culture, says Dr Ko.

“When a place has good culture, achieving quality improvement is going to be easier. When you go to a place that does not have a good culture, does not have good communication, we know they have an uphill climb for improvement,” he says.

“To achieve excellence, we are all going to have to share the passion to stay on top of these things, and we are all going to have to be a part of that team that recognizes we are in this together.”