Plastic Surgery Tool-Kit to Build a Culture of Patient Safety, Quality, and Service

Purpose:  Despite the increasing importance of quality assessment and improvement initiatives in health care, national quality measures and patient safety practice guidelines remain difficult to define in plastic surgery.  A specialty that frequently offers life-enhancing procedures, plastic surgery may have an increased reliance on patient-reported outcomes and clinical quality indicators.  Specialty-specific, comprehensive, departmental frameworks for patient safety, quality, and service have yet to be described, providing us with the opportunity to standardize and improve quality of care.  We describe a dynamic model for quality improvement used successfully for three years in the Johns Hopkins Department of Plastic and Reconstructive Surgery and provide a tool-kit for implementation across various practice environments.

Methods:  Drawing from three years of experience using a Comprehensive Unit-Based Safety Program, formal quality improvement committee structure, literature review, and work from The Johns Hopkins Armstrong Institute for Patient Safety and Quality, we devised a framework specific and exportable to the field of plastic surgery.

Results:  Our departmental structure provides channels to facilitate inputs and outputs of naturally trending and recorded data.  Monthly Patient Safety, Quality, and Service Committee meetings are a transparent way to address important topics and expeditiously make appropriate changes.  Meetings are attended by departmental administration, physicians, physician extenders, support staff, and trainees and are structured in a bottom-up fashion to encourage multi-level participation.  Four key domains are addressed: (1) safety, (2) external measures, (3) patient experience, and (4) value.  Examples of indicators include hand washing, pain management, rate of postoperative hematoma, readmission rates, the Breast-Q Reconstruction Survey, and auto-scheduling (pre-scheduling) of postoperative clinic appointments.  The core team identifies opportunities and needs; develops, implements, and tracks improvement plans; and celebrates and advertises accomplishments to colleagues, the institution, and the public.

Conclusion:  We believe that this formal departmental quality improvement structure promotes excellence and national leadership on externally reported measures of patient safety, quality, and service.  We provide other plastic surgery departments and divisions with an adaptable framework amenable to different settings. This work becomes increasingly relevant as value-based reimbursement and pay-for-performance initiatives are implemented to drive improvements in healthcare.