Quality and Safety in Colon and Rectal Surgery
Over the past 15 years, a series of high profile events including the publication of the Institute of Medicine Reports, To Err is Human (1999), and Crossing the Quality Chasm (2001), along with the rapid adoption of quality-based regulatory requirements a
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Key Concepts • Measurement of quality can be separated into structural, process, and outcome-based. • Quality measures in colorectal surgery are both process and outcome-based. • Transforming healthcare to a high reliability organization will provide the infrastructure for continuous quality improvement. • Creating a culture of safety is essential for delivering high quality care. • Patient and family engagement has emerged as a new and equally important domain of quality.
Background In 2000, the Institute of Medicine (IOM) published the report To Err Is Human: Building a Safer Health System, a landmark document which raised awareness of the magnitude of the problem of medical mistakes, and remains the most frequently cited document in the medical literature in recent years [2]. The IOM report shocked both the healthcare community and the public by concluding that 44,000–98,000 deaths and over 1 million injuries occurred each year in American hospitals due to medical error. In fact, preventable medical errors represent one of the eight leading causes of death in hospitalized patients. As this report was disseminated, general awareness about medical errors increased, and physicians and other health providers began speaking openly about mistakes and the difficulties they face when dealing with them. The IOM report brought much-needed attention to the field of quality and safety. In addition, it standardized the language used to describe errors in medicine, defining important terms for future research and quality improvement. Following its publication, interest in the field increased exponentially and health services researchers began to collaborate with scientists from other disciplines such as engineering,
psychology, and informatics to develop innovative solutions to longstanding lapses in quality and safety. A follow-up report in 2001, Crossing the Quality Chasm: A New Health System for the 21st Century, provided a framework for how to re-work healthcare delivery in the USA [3]. The report called for federal and state policymakers, public and private purchasers of care, regulators, organization managers, governing boards, and consumers all to commit to reducing the burden of illness and to improve the health of the American population by focusing on making healthcare safe, effective, patient-centered, timely, efficient, and equitable (Figure 71-1). To meet these goals, the report outlined ten rules for redesign: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Care is based on continuous healing relationships. Care is customized according to patient needs and values. The patient is the source of control. Knowledge must be shared and information flows freely. Decision-making should be evidence-based. Safety is a system property. Transparency is necessary. Needs need to be anticipated. Waste should be continuously decreased. Cooperation among clinicians is a priority.
The next milestone for the safety and quality movement was the Patient Protection and Affordable Care Act (i.e., “Affordable Care Act” or “Obama Care”), which was signed
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