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A:

How Do You Take a Quality Approach to Surgery at Your Own Institution?

We’ve really taken a team approach, a multidisciplinary team approach, to look at how surgical outcomes have less to do with the exact technical parts of surgery but more to do with how we approach the patient holistically from the first interaction to well after surgery. In fact we’ve developed this with lessons from approach with an organized to optimize team dynamics and to remove cultural and organizational barriers to care. Our success has been outstanding.

What was this approach that you used? Was this a secret sauce?

CUSP (the Comprehensive Unit-based Safety Program) started as an approach from Johns Hopkins safety research on how they could develop safety techniques from high reliable organizations like nuclear submarines and aviation and apply them to how teams work in the operating room and ICU. It’s really inspiring how teams have taken on these concepts and applied them to their own concerns, own them, and develop processes with their frontline wisdom and experience to make care better.

How Has This Quality Approach to Surgery Impacted Patient Care?

We have patient coming from all over the world, problems which are extremely difficult and too high risk to help with. NYP takes and approach from the very highest levels with a palpable difference in the cultural feel on the importance of quality and respect for people. Important too is the bottom up approach of leveraging the power of the group, the wisdom of crowds for driving improvement.

We do over 300 surgeries a year, over 20 fusions a month, and we are a major referral center for children with complex pediatric spine problems. So, we’re extremely proud of our extraordinary track record. We would expect far more infections then we currently see. It’s not about the surgeon. It’s not about the technique. It’s about people, nurses, infrastructure, and organization change and leadership, the power of the team and the power of the wisdom of crowds. I’m really proud to facilitate that in this organization. So, we’re extremely proud of our extraordinary track record.

I really like how you mention both a top down and bottom up approach. What are some of the pillars that make up this philosophy around making care better and driving quality?

The hospital’s three tenets of extraordinary care—quality and safety, patient experience and great working environment for the staff—are evident from not only a full year without an SSI, but also the heartwarming letters my team receive from the children they’ve treated and their parents, and the dedication the staff shows to improving patient outcomes.

Using everyone’s commitment to make care better, we brought together a team to implement a framework that would bring our infection rate down to zero.”

By asking, “How will the next patient be harmed?,” we can figure out everything that’s wrong, from surgery starting late to a trash can placed too far away from a surgeon. We’re able to start with the day before surgery to prep the patient and the room and continue all the way to recovery. That reduces the harried need to compensate for mistakes, which lessens the chaos.

By jotting down every problem—big and small—the team creates mutual goals, such as to prep the OR earlier, start surgeries on time and decrease room traffic, which reduces potential sterility breaches. The early prep work breeds efficiency, ensuring x-rays hang properly, equipment is readily available and neatly organized, and trash cans are easily accessible but are not obstructions.

What about throughput?

We’ve increased flow of patients through processes, reduced inefficiencies and waste within the hospital, and hopefully made it a better and safer place to deliver the best care possible.

The results speak for themselves, but will they last?

“To sustain change, you need to create a sustainable culture. That’s what we’re doing when we listen to the voices of everyone on the front lines. The people on the front lines create the checklists, change what’s on the checklists and are given a voice.”

If you want to see long-lasting change in the system, there’s no better place to start than within your own institution and within your own team. This way, you may work to improve your quality approach to surgery.

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