The Power of Collaborative Improvement

Guest Blogger

“Keep the quality up” are words immortalized and reminisced for over a century in my adopted hometown. The number of spine surgeries has approximately doubled over the last 10 years,1 with spinal fusion becoming the dominant intervention for procedures. Back pain is a common ailment, and new procedures and adaptations of those procedures have been developed.  The surgical approach to back pain has become varied and the endorsement of multiple approaches each advocates its own success over another. To address this, the Michigan Spine Surgery Improvement Collaborative (MSSIC) represents a community of physicians and Blue Cross Blue Shield coming together to improve spine care in Michigan.

The collaborative is a registry of all the participating practices in which outcomes, patient selection, risk factors, other quality metrics such as infection, reoperation and readmission, length of stay, and other components of outcome are collected.  Using chart abstraction and centralizing this data allows an equal sharing of that data with all of the other participating practices.  Blue Cross Blue Shield of Michigan funds the data abstracters and the data base, a significant financial support.

The collaborative results in improvement, meaningful to the patient, physician, payer and other stakeholders.  This emphasis on self-evaluation and analysis, not just through comparison of others involved in the collaborative, but with a self-imposed mandate of improvement of care delivery and outcome meets and fulfills a meaningful use requirement legislated by the government.  This approach seems to also fulfill meeting a patient-centered outcome improvement mandate.  The collaborative should result in the identification of “best practice” through easy comparative analysis and evaluation of active and real-time comparison of everybody’s practice.  The power of change comes directly from the practitioner and remains with the active engagement of other clinicians who have a similar purpose and goal.  The end result for the clinician is a patient-centered improvement of outcome.  By emphasizing the patient as the primary reason for change, the benefit is improved outcome and care for the patient with a reduction of cost.  The net result is a win/win/win situation for all the players involved in medical care.

The goal of the collaborative is simple – to improve spine care.  Resulting effects include shorter stays, less expensive treatment, and more effective and longer lasting treatment options through real-time comparisons.  The ability to visualize oneself and compare one’s own practice with others who have like-minded goals is extremely powerful.  It creates a cooperative environment and produces more effective treatment.  The collaborative allows the individual who has a smaller number of contributing results to be among a group with larger numbers, to be adaptable and changeable in a dynamic setting and more effectively and seamlessly adopt change.  The adoption of this kind of approach has the patient as its goal and focus.

The beauty and the power of an individual physician combined with other physicians with like-minded goals using clinical data collected at point of care strongly drives care improvement.  The power of change comes from each physician.  Changes occur in real time with an active conscience of how one can improve one’s practice. The collaborative represents, for me, the paradigm of practicing medicine. It has the patient as the center of care and that is a win for me.


Mark Krinock, MD, is a neurosurgeon at Borgess Medical Center in Kalamazoo, MI.

1 Dartmouth Medical Atlas

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