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Quality, reliability, repeatability—What about excellence?

Harrington, David T. MD, FACS

Journal of Trauma and Acute Care Surgery: November 2017 - Volume 83 - Issue 5 - p 794–797
doi: 10.1097/TA.0000000000001698
Proceedings from the 2016 Festschrift Honoring Basil A. Pruitt, Jr., M.D.

ABSTRACT Today, I will be giving a general overview of the quality question. I will divide quality into four topics: first essential element—data, second essential element—process, third essential element—culture, and hidden dangers. We were fairly “high on the hog” in the House of Surgery in the late 20th century but then came the Institute of Medicine (IOM) reports. Partly in response to the IOM reports, we have discussed incessantly airplanes and aircrews. However, this is not the only challenge for in addition to this quality problem, we have a cost problem. These intersecting challenges appear insurmountable, but there is hope. We need better data, better process, and an evolution of our culture. The easiest type of data to collect is process measure data. We should all be aware of Surgical Care Improvement Project (SCIP), Physician Reporting Quality System (PRQS), and Merit-Based Incentive Payment System (MIPS). On the performance measures side of the house, the National Surgical Quality Incentive Program and the University Health-System Collaborative are major initiatives. There is an abundance of data, but if we are to improve care, we also need a good process. There is increased attention into process such as checklists, bundles, and standard operating procedures. Data and process is important, but we also need to be strategic. For a process to be effective, it needs to be part of a coherent strategy. And once we have data, process, and strategic thinking, we come to the third essential element, which is culture. Are there some dangers in embracing these new approaches? In a word, yes. We cannot abandon the traditional role of surgeons as leaders. We need to think about training the next generation of surgeons and the risk that this over-systemization of care begets. Surgeons have always led change, so though these new challenges seem profoundly disruptive, I am sure that we will again rise to the task.

From The Warren Alpert Medical School of Brown University and Rhode Island Burn Center at Rhode Island Hospital, Providence, Rhode Island, United States.

Submitted: August 31, 2017, Accepted: September 1, 2017, Published online: September 13, 2017.

Address for reprints: David T. Harrington, MD, FACS, The Warren Alpert Medical School of Brown University and Rhode Island Burn Center at Rhode Island Hospital, Providence, RI; email:

© 2017 Lippincott Williams & Wilkins, Inc.