Accreditation Council for Surgical Quality | Co-operation Among Hospitals Has Life Saving Consequences

Co-operation Among Hospitals Has Life Saving Consequences


Pejman P. Samouha, MD, Shawn M. Haqqani, BA
Los Angeles, California

The lack of transparency into the workings of various hospitals has been a large barrier to possible collaborations in order to reduce surgical complications and improve surgical quality. In order to create the highest possible standards to which all hospitals must achieve, a coadjuvency among those who have the power to enforce change must exist in order to further shape future requirements and acceptability in the field of surgery.

The Michigan Surgical Quality Collaborative has instituted such principles with successful outcomes. Among the 16 hospitals that participated in the MSQC collaboration, surgical complications were reduced by 9.7 percent after the institution of information sharing, down from 10.7 percent prior. Understanding the large number of patients undergoing surgery every year, such measures in reduction in rates of complications underscore the necessity of procedureal change. The policy institutions has additionallyy resulted in the hospitals wide savings to the University of Michigan Health Systems of $13 million on cases of ventilator-associate pneumonia alone.

Institutional long-term goals among specialties of surgery are focussed to improve overall health quality while reducing overall all costs. Such goals however, often provide for conflicting tangents. The collaborative strategy of information sharing however is one such solution. The collaboration of hospitals in terms of identifying and disseminating information about best practices is actually a much more effective way of improving quality than just relying on each hospital alone to come up with what they think is a way to improve quality. The understanding of sharing ideas is important and effective in improving the quality of healthcare while providing real measures at reducing overall costs..

In evaluating the results of information sharing the MSQC had financial support from Blue Cross Blue Shield of Michigan and its Blue Care Network which not only pays hospitals to undergo the studies but shoulders the burden of the associated costs of the technology needed to evaluate the data. Hospitals explicitly share information amongst each other; however the results from individual hospitals are not divulged to the BCBS. It's an arrangement that facilitates teamwork towards a common goal, beyond competition. Such approaches such as pay for participation rather than pay for performance are new strategies with proven benefits. Pay for participation means that a hospital receives money from Blue Cross Blue Shield simply for participating; and doesn't depend on the results obtained. Such fosters a less competitive atmosphere. This provides for the sharing of their best ideas making the collaborative work. More importantly the lack of a correlation between financial support and results ensures that accurate and reliable data is submitted and reasonable conclusions can be drawn upon them.

Recent studies have examined vascular and general surgery, both scheduled and emergency surgeries performed between April 2005 and December 2007. The most notable improvements were evidenced by a lowering in blood infections, septic shock, prolonged ventilator use and cardiac arrest. However interestingly there was no difference in overall mortality. Despite this fact, surgical complications provide a heavy cost burden on the healthcare system requiring a large dependence on available resources. Thus efficient ways to eliminate or contain costs are to reduce complication rates which sharing of patient data accomplishes. A surgical complication can add weeks if not months to a hospital stay along with thousands of dollars in auxiliary costs. Patients who are afflicted with pneumonia serve as a demonstrative example. Prolonged ventilator use following a surgical procedure can add $60,000 or higher to the original hospital bill. Errors and complications in medicine and in the field of surgery more specifically, can have grave financial consequences which further evidences the priority reducing surgical complications has in the long-term goals of the future of health care.Given the debilitating cost of surgical complications, an estimated 1.8 percent reduction in complications per year for a total three years would offset the cost of supporting the Pay for Participation Program. The adoption of such hospital wide policies nationally, rather than at single institution levels would accelerate the pace of surgical quality improvement. The MCSQ has spurred similar surgeon initiatives in various locations across the United States including Tennessee as well as New York have launched joint programs. Similar actions are being planned in Pennsylvania, Virginia and Illinois; a nationwide involvement could potentially give rise to a new wave of surgical standards that would not only save time and money, but will eventually in the long term save lives as well.

Campbell DA, Englesbe MJ, Kubus JJ, et al. Accelerating the pace of surgical quality improvement: The power of hospital collaboration. Arch Surg. 2010;145(10):985-991.