Continuous Improvement is Expected
Several years ago, after becoming board certified in urology, I applied to become a Fellow with the American College of Surgeons. I prepared a list of my surgical cases and complications and arrived for the required interview and interrogation. Being somewhat appropriately nervous during the interview, I can’t recall many of the questions that I was asked. The message that I took away from that experience, however, was very clear. A commitment to continuous surgical improvement was an expected part of membership in the college.
Searching for a Methodology
As I began my career, I first kept notes of my surgical successes and complications on paper. Over time, I moved to a spreadsheet. Not only was the process time consuming, it was difficult to directly compare my surgical experience with that of others. Differences in reporting were readily apparent even in the academic literature. There really didn’t seem to be any universally accepted standard for reporting in Urology. As a result, it was difficult to know exactly where to try to focus my continuous improvement efforts.
Michigan Urology Surgical Improvement Collaborative
A couple of years ago, a solution started to emerge. The University of Michigan, under the leadership of Dr. David Miller and Dr. James Montie, initiated a statewide collaborative between academic and private practice urologists. This collaborative, financially and administratively supported by the Value Partnerships Program at Blue Cross Blue Shield of Michigan, became known as the Michigan Urological Surgical Improvement Collaborative (MUSIC).
A diverse group of practices from all over the state started participating.
Each participating group chose a physician leader and employed a designated data abstractor. Outcome measurements were defined by physicians and entered into a standard database by the abstractors.
Discussing and Interpreting the Data
Physician leaders and abstractors from around the state then started regularly meeting to look for trends, and to try to identify opportunities for patient care improvement. As the data started to mature, it started to become possible to have real discussions around the best standard of practice, both at the statewide level, and at the individual practice level.
In our own practice, some of these discussions have been intense. Not everyone agrees on the best way to interpret the data. In my experience, however, these discussions have always been respectful and productive.
Creating Value and Building Relationships
These days, quality improvement initiatives are seemingly everywhere. Many of these initiatives are in reality a distraction, taking physician time away from direct patient care. Physician leadership and feedback are often lacking in such activities, thereby limiting the potential to facilitate meaningful change.
MUSIC has turned out to be more than just an exercise in agreeing upon metrics and collecting data. It has been an opportunity for academic and private practice urologists to ask the questions and learn from each other in an effort to continuously improve urological care.
Working together “in concert” also includes patients.
Soliciting and involving the patients fully in decisions, and helping them make better decisions, is something we are all interested in, and working towards quite expeditiously. – Dr. David Miller
A Video About MUSIC
The interview starts out with general information about the program but relatively quickly begins to demonstrate the interactions and collegiality made possible by the program. As a private practice urologist in a relatively small community, I am excited and proud to be involved in the MUSIC initiative. I truly appreciate the relationships and improvements in patient care that have become possible as a consequence of this effort.
To think about why this works is there’s some secret sauce to the combination of the relationships, the data, the fact that we are competitive, and we all want to get better … What the collaborative does is it provides us with a “community of coaches” to think about how we provide care, to offer constructive feedback that we can take and improve upon, and then close the loop, to see if we are actually getting better.” – Dr. David Miller
Note: This blog originally appeared on the Best Doctors Clinical Curbside site.
Brian Stork, MD, is a urologist in practice at West Shore Urology in Muskegon and Grand Haven, MI