Quality Management Committee

Written by Ali Sarram, MD, Advanced Urology

As I remember, Kelly Gallant, the Assistant Vice President for Quality and Performance Improvement at The Medical Center of Aurora, came up to me sometime in late spring and told me about my new responsibilities as the chair of the Quality Management Committee (QMC). My first reaction was, "Huh?" As it turns out, Alan Aboaf, MD, had failed to inform me of a little detail, that somewhere along the way the decision was made to bestow upon the President Elect the honor of also heading up the QMC of the hospital. A list of a few thoughts that went though my head at that time included: What is QMC? What does it do?  Why does it matter to me as a member of the medical staff? What does Alan drive, and how many tires....!

Well, I have gone through the mother of all crash courses over the past couple of months. Dr. Jeff Turk has spent much time and energy bringing me up to date with my role as the chair of the QMC. Kelly Gallant and Dr. Dennis Waite have patiently sat through hours of mind numbing meetings, teaching me all about the meaning of meaningless terms such as OPPE, FPPE, RCA and FMECA. Looking at performance charts, I have learned that GREEN is better than YELLOW, and YELLOW is better than RED (although as a Urologist, I take exception to this color hierarchy.  As far as I am concerned, yellow rules!). 

Anyone who has paid attention to national discourse about health care reform over the past few months has heard terminology such as, "cost effective delivery of high quality health care". To you and me this means nothing more than what we do on a daily basis. Physicians, for the most part, get up in the morning, go to work and do their best to deliver the highest quality care to as many people as they possibly can, in the most cost effective way our system allows. Right? End of story! Why should anyone else even bother to worry about the type of care we deliver, when we KNOW we do such a good job?

Well, in real life, for good or bad, insurance companies and the government have become increasingly more inquisitive about these issues, and consumers have an increasingly greater access to information about quality and value of care delivered to them. The problem as I see it, is that the metrics used to measure quality of care do not resonate well with what happens on a daily basis in our practices.

For example, we are considered remiss of quality care if antibiotics are given one hour and one minute prior to incision time, and are considered exemplary surgeons, worthy of color GREEN, if antibiotics are given 59 minutes prior!  My first reaction to such nonsense is not too unlike many other colleagues, who understandably take a cynical view of this process. It is the big brother, trying to force upon us cookie cutter medicine. It is the end of independent thinking in medicine, and the death of the ART of medicine! 

I have had all these thoughts, and yet have come to accept this as yet another game that we have been forced to play. This is not much different from having to reduce our patient's ailments into neatly organized categories of ICD diagnoses, none of which really represent the diseases that our patients experience, nor the art with which we try to treat them. Quality measures may not represent what we do, but we simply have no choice but to accept them as present and dangerous. It is my firm belief, that the doctor who plays this game the best is going the be the one who is left standing at the end of the day!

Now, why should we, as independent, private practitioners, care about core measures in the hospital? Unless we are somehow employed by the hospital, should we care to contribute to excellent quality scores (GREEN on the chart!), which at first appear to only benefit the hospital?  Why should we take time out of our busy days to make sure that forms are filled out properly and the correct wording finds itself into the patient's chart? The medical staff at The Medical Center of Aurora is well known for our high quality, collegiality and excellent outcomes. I hope that over the next few months, I can successfully convince you that the hospital's reputation as a quality institution will eventually reflect positively upon the independent medical staff. 

Inversely, if this hospital is found to be in the RED in quality outcomes, it will sooner or later reflect negatively on our individual practices. Who in the medical staff would not benefit from The Medical Center of Aurora being recognized as a top notch hospital?  Which surgeon would not benefit if our operating room is known for being the best, cleanest, most efficient and with the best outcomes in the city?  Which medical specialist would not be proud to admit their patient to a hospital that is regionally and nationally known for quality of care?  Additionally, sooner or later, data about individual physicians and their individual outcomes will be available to the public.  We may as well learn to play this game now, before our feet are held to fire.

In the future, you will find periodic updates on quality measures in this hospital.  When you see charts that compare us to other hospitals in the city, I would like you to pay attention to our hospital's scores. When you see GREEN, I challenge you to identify how you have contributed to this excellent score, and how you can prevent us from falling out of GREEN. When you see YELLOW or RED, I would like you to ask yourself what you can do to lift us back into excellence.  It will take a concerted effort by each and every one of our medical staff to get the data to reflect what we already know: We practice in an environment of excellence.  We provide medical care second to no other institution in this region. We truly are deserving of the color GREEN!