A key component of the Collaborative’s mission is to create opportunities for surgeons and hospital quality leaders to come together to share challenges and successes.
– Caprice Greenberg, Director of SCW
At a Glance
This project sought to develop the Surgical Collaborative of Wisconsin (SCW), a cost-efficient statewide collaborative to improve the quality of surgical care. The interest and engagement of surgeons and hospitals has surpassed the initial goal of involving 24 hospitals in the initiatives. SCW engaged 85 hospitals, where nearly 75 percent of breast and colorectal procedures are performed. There has been a significant reduction in reoperations in SCW participating vs non-participating hospitals. This project was also successful in establishing new partnerships, new initiatives, and supporting quality improvement in surgical care.
The Challenge
Surgery is a common and expensive procedure that results in 8 million hospital discharges per year and costs $1.58 billion per year in Wisconsin, while surgical care accounts for 50 percent all of hospital and 30 percent of total healthcare costs in the state. Given this tremendous scope and scale, it is no surprise that the quality of this care whether looking at the institutional and surgeon levels varies, even when there are evidence-based practices to guide care. Second operations, longer length of stay, surgical complications, and readmission to the hospital all lead to decreased patient satisfaction, lower quality, and higher costs. Thus, more resources need to be allocated to support surgeons and hospitals in improving the quality of care and decreasing the cost of care.
Project Goals
The overarching goal of this project was to develop the Surgical Collaborative of Wisconsin (SCW), a cost-efficient statewide quality improvement collaborative. The grantees also proposed to evaluate the collaboration’s effectiveness in increasing statewide adoption of breast and colorectal cancer evidence-based practice. The grant team outlined three different aims for this project. The first included developing capacity for producing and distributing standardized performance reports of surgical quality measures, with an initial focus on breast and colorectal cancer. The second was to determine surgeon and hospital-level facilitators and barriers to providing guideline-concordant surgical care for both breast and colorectal cancer, as well as for surgical improvement initiatives in general. The third was implementing a statewide quality collaborative and evaluating its impact on the adoption of best practices and outcomes in breast and colorectal cancers. The Surgical Collaborative of Wisconsin (SCW) set a goal of engaging 24 hospitals in Wisconsin to improve the quality of surgical care delivered in the state.
Results
This project was successful in achieving its goals. In fact, the interest and engagement of surgeons and hospitals has far surpassed the initial goal of involving 24 hospitals in the initiatives. To date, SCW has engaged 85 hospitals and 200 surgeons. Nearly 75 percent of breast and colorectal procedures are performed in an SCW engaged hospital. Hospitals that participated in SCW saw a significant reduction in breast reoperations as a result of the high level of engagement with the collaborative.
This project was successful in establishing new partnerships, new initiatives, and supporting quality improvement. Through the work of the Collaborative, new partnerships have been formed with the Rural Wisconsin Healthcare Cooperative, and Wisconsin Collaborative for Healthcare Quality, and the Wisconsin Medical Society. Through surgeon engagement, SCW identified new initiatives including efforts to reduce opioid prescribing post-surgery, supporting rural efforts to improve the quality of colonoscopy procedures, the development of a rural collaborative network for education and engagement, and a focus on a multidisciplinary approach to enhanced recovery. Finally, by engaging with state partners, SCW has identified the role that policy can play in healthcare quality.
Looking to the Future
Using the infrastructure developed throughout this project, SCW has taken steps to ensure these improvements can be sustained. The team has secured funding from the Hendricks Foundation to reduce post-operative opioid prescribing, from the National Cancer Institute and the Carbone Cancer Center to improve measurement and engagement infrastructure in Rural Wisconsin, and from the AAA Quality Fund from the Department of Surgery to continue implementing enhanced recovery after surgery.
Lasting Impact
Through the long-term engagement of surgeons over the course of this project, the grant team gained valuable understanding of the multidisciplinary care team supports that are needed to implement protocols to enhance recovery after surgery in the state. The grantees also identified a critical need to improve the measurement of performance in rural low volume hospitals through adoption of approaches endorsed by the National Quality Forum and engagement of rural hospitals in quality improvement efforts. This work led to the establishment of a Rural Task Force within SCW. The goal of this task force is to identify areas and initiatives that would address the specific needs and challenges of rural surgeons and hospitals. The SCW Rural Task Force has partnered with the Rural Wisconsin Health Cooperative and the Wisconsin Collaborative for Healthcare Quality to launch an initiative focused on helping rural surgeons improve the quality of colonoscopies delivered in rural settings.
