Quality control:
why you can’t afford not to care

 

What does quality really mean in a clinical setting and why should surgical units invest in creating a positive patient experience?

 

You’d be forgiven for thinking that when it comes to surgery, the notion of ‘quality’ hinges on a pretty simple exchange: the patient needs surgery, the surgeon successfully operates. However, modern patients expect much more. They’re not looking at surgical success alone – instead, they expect the highest quality in the administrative procedures, surgical treatment, in-hospital comfort and follow-up care. Surgical units that don’t keep up with this expectation will soon be left behind.

​“Quality has taken on a completely different meaning in the past few years. It corresponds with a change in our expectations of life.”Professor S Rajasekaran

Quality – Another name for safety

Every good surgeon has ‘patient safety’ as their first priority and knows that this can be achieved only by ensuring quality to the highest standards. Surgery, although an important event, is still only a small part of the whole chain of treatment which starts with consultation, investigations, preoperative preparations, operating theatre status and meticulous postoperative care and rehabilitation. The entire process has to be under constant quality check as a slip in quality at any point of this process can result in major complications. A chain is only as strong as its weakest link. So it’s important that the surgeon, as the leader of the team, enforces and supervises good quality control for the entire team.

 

 

Quality at a glance

Professor Rajasekaran presents his
5-step guide to quality improvement

 

1. Perform a rigorous audit of patient experiences, medical procedures and outcomes to measure your current position.
2. Appoint a quality manager from outwith the core medical team with specific responsibility for process improvement.
3. Use a goal-based rewards system to provide additional motivation to staff who do not have contact with patients.
4. Invest in the infrastructure, technology, processes and personnel required to create the right environment.
5. Promote your successes online and share best practice to achieve ‘critical mass’ and drive standards across the profession.

 

A buyers’ market

Yet while hospital environment, comfort of stay and food might seem like trivial concerns, these small everyday details are things that patients can control, even in the face of a frightening medical condition. This creates an element of choice – a key driver in quality improvement.

 

“Quality is no longer an option, because patients have access to vast amounts of information in the digital age,” says Prof Rajasekaran. “Many of the top ranking surgical units post their results on their web pages. This isn’t just heartening patient feedback quotes, but rigorous data on operation times, infection rates, success rates and more. Patients thereby have knowledge of the very highest standards of treatment and they demand it. We are effectively operating in a buyers’ market, and that creates a strong element of competition.”

 

The sums add up

Of course, in this fierce competitive environment only the strongest units will survive, but Prof Rajasekaran believes that this is a welcome and positive force for change. The argument that quality comes at a price is a valid one – Ganga Hospital made a “huge investment” in infrastructure, personnel and technology when it embarked on its quality accreditation – but Prof Rajasekaran argues that the cost of poor quality is far greater.

 

Take for example a routine microdisectomy surgery. In an ideal scenario, the patient is quickly discharged, has two short follow-up appointments and the result is a positive one for the patient and the medical team. If, on the other hand, the patient sustains an infection, the financial cost of readmission, multiple follow-ups and potential further operations all stack up. Additionally, many insurance companies now tie their reimbursement policies to quality control frameworks, expecting hospitals to prove their commitment to better patient care.

 

“The answer is to hire a dedicated quality manager from outside of the core medical team.”

 

 

 

Peace of mind

“In financial terms the cost of poor quality is much higher than the initial investment,” says Prof Rajasekaran. “Even looking beyond finance, the value derived from quality improvement is clear to see. Consider reputation, one of the key differentiating factors in surgical units. When more patients come to your surgery you achieve critical mass, and everything becomes affordable. Finally, you might consider the value of your peace of mind. Surgeons who excel within an outstanding professional environment can enjoy their work, and sleep easy when they close their eyes at night.

 

“Professional achievement, reputation, performance and patient outcomes all hinge on getting it ‘right the first time, every time’. As a profession we need to invest in quality, from teaching these skills at medical school right through to equipping units with the necessary technology. It’s the stepping ladder for a truly patient-focused medical service.”

 

​Professor S Rajasekaran Professor S Rajasekaran, RS, MD PhD is a spine surgeon and chairman at the Department of Orthopaedic and Spine Surgery at Ganga Hospital (India). He is chair of the Research Commission since 2015 and a member of the Knowledge Forum Trauma.