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Improving surgical quality has become increasingly important to hospitals as providers are pushed to shoulder more risk under value-based reimbursement models. Given that surgery patients account for a significant portion of a hospital’s preventable costs (for example: unplanned intubation, severe sepsis, pulmonary embolism, and organ space
surgical site infection), quality and efficiency improvements can strongly impact the
bottom line.

Quality, as with most things, is multifaceted. Outcomes are partly attributable to the quality of care surgery patients receive throughout their hospital stays. Of course, the technical quality of surgical procedures is also a major factor. The challenge for surgical quality officers, then, centers on bolstering current surgical training methods. Doing so improves not only the technical quality of surgeons across various procedures, but also the operating room processes themselves.

Providing opportunities for feedback

Clinical observation and a large volume of evidence suggest wide variation in the technical quality and skill among surgeons. That’s due, in some measure, to a lack of continuing education, a key component of which is peer interaction. For example, surgeons who engage in higher levels of peer interaction have a higher likelihood of passing a maintenance of certification examination, and higher scores, according to a 2014 study of 568 surgeons published in JAMA Surgery.

Certainly, surgeons have the potential to improve much faster after their formal training with both purposeful practice and meaningful feedback, best delivered through peer interaction. The problem is that surgeons rarely watch one another operate and generally have no source of feedback on how they can improve once they’ve completed training. That is changing, though. As a result of the evolution of surgical practice toward videoscopic and robotic surgery, surgeons have new opportunities to obtain practice and feedback in more impactful ways than ever before.

Following the digital trail

Thanks to the “digital trail” of data from such surgeries, advances in technology and analytics
have created opportunities for evaluating surgeons’ techniques. The digital trail includes realtime
information on a patient’s history, vital signs, imaging and other parameters.
It’s also increasingly feasible to collect and synthesize information from surgical instruments
and clinical workflows to drive surgical performance. Akin to the black box in aviation, the
digital trail records everything (video, conversations, data, images, etc.). Through analyzing
such data, surgeons can find the root causes for the complications that put a patient and
hospital at risk.

Looking beyond surgeons

Leveraging data and performance-focused analytics offer the potential to improve all aspects of a surgical team’s performance, including operating staff members – critical, given that studies show operating room time costs well in excess of $1,000 per hour. Establishing a culture of safety and quality among staff can be challenging due to high rates
of turnover, which create knowledge gaps throughout a system.

However, the digital trail of data from surgeries also informs OR staff members and helps
them improve performance through training modules and checklists of best practices. The
recordings and data can be used to create these training modules, which are more than just
simulations, but real patients under actual conditions.

Even small improvements in the process efficiency of surgery staff members have the
potential to deliver a disproportionate impact on surgical quality, which can enhance
hospitals’ financial performance in value-based reimbursement models.


New technology allows surgical quality officers to bring both rigor and innovation to training
models. It also offers a pathway for surgeons to improve technical skills. By providing
purposeful practice and meaningful feedback, following the digital trail of evidence, and
looking beyond surgeons to staff, hospitals can upgrade surgical training to boost quality and
lower costs.

About the author: Dr. John Birkmeyer is the chief clinical officer of Sound Physicians and a
member of the board of advisors of caresyntax, a surgical data, analytics and automation

This piece originally appeared in DotMed/Healthcare Business News on July 31, 2018. View the article here.