By Sharon Pound, Knoxville News Sentinel Special Publication
When you’re a patient at the doctor’s office, how do you measure quality? Most people just want the doctor to fix their problem, as quickly as possible.
From the moment patients walk through their doctor’s front door, maybe even the moment they call to make an appointment, many things impact the quality of health care they receive. The leaders at Premier Surgical want to learn more about that.
“When you call and have pain, you want to know if you can see someone today,” says Dr. Stone Mitchell, medical director, surgeon, and chair of Premier’s quality committee. “Four to six weeks is not good enough.”
Mitchell is working closely with Dr. Will Gibson, general surgeon and partner at Premier, to drive a quality initiative at Premier. Gibson is chair of the leadership committee of the Tennessee Surgical Quality Collaborative, and serves as a “Surgeon Champion” for a nationwide hospital program called the National Surgical Quality Improvement Program.
“The goal is to measure outcomes and know an organization’s strengths and weaknesses. Then, work to improve those weaknesses. Hospitals need surgeons to interpret their surgical outcomes,” Gibson explains.
At Premier, the initiative seeks to measure successful resolution of problems with a minimum of complications.
Premier Surgical is bringing the model of the national program to private practice. They have hired QCMetrix, which helped implement the national program’s standards for the Veteran’s Administration. The Massachusetts firm brings the power of “big data” to healthcare, offering user-friendly surgical outcomes data platforms and services. These services begin with data capture, which is the key to meaningful quality analysis. Other important components are data validation, storage and, finally, the data analysis.
QCMetrix has a strong reputation in this new area of helping healthcare providers tap into today’s powerful computing capabilities for the benefit of patients. The national program reports that the benefits of such initiatives can include savings in the millions of dollars, shorter and fewer stays in the hospital, and happier patients.
“We’ve taken it upon ourselves to formally quantify our outcomes for the purpose of improving them,” Gibson says. “We’re the only private group in Tennessee, maybe across the country, on this leading edge.”
The surgeons at Premier Surgical, on average, treat 20,350 patients a year. They log approximately 15,000 surgeries a year, with 11,000 general surgeries and 4,000 vascular surgeries. They serve an 18-county region, have relationships with all the major carriers and provide services in both the Covenant and Tennova systems. Premier also maintains a strong relationship with sister groups in Chattanooga and Nashville, bringing together the expertise of more than 80 surgeons.
“We take care of 75 percent of the vascular surgical care in the Greater Knoxville area,” Mitchell estimates, noting that Premier is the largest general vascular surgical private practice in East Tennessee. “Our general surgeons are the backbone of surgical care. They enable the ‘critical’ in critical care. ”
Cancer, especially breast cancer, represents the largest demand for their services, he adds. Premier’s large patient numbers make the practice an ideal place to mine for meaningful data that can make a positive difference in healthcare, Mitchell suggests.
The process started in 2014, as they began to work with QCMetrix to implement the national model. The first step was a random sample of cases for each surgeon. A system has been developed to identify relevant data points to track and then investigate the data to measure those quality metrics.
“We will be able to measure against national standards and also among each group within Premier,” Gibson says. “Among other things, this will allow us to identify professional development opportunities.”
Mitchell notes that the data will also confirm the practice’s strong areas. “When we tell people we’re the best trained, we’ve been here the longest, everybody loves us, we’ll be able to back this up with measurable data.”
“We’ll shift from hearsay to what’s real, based on best-practice protocols, evaluation and monitoring,” he adds.
When they speak about quality healthcare, Mitchell and Gibson invoke the spirit of a report published in 1999 by the U.S. Institute of Medicine called “To Err is Human: Building a Safer Health System.” Many credit that report for increasing awareness of medical errors.
Gibson notes that positive outcomes for patients include avoidance of problems, such as infections and pneumonia. These will be some of the data points they collect in their analysis.
“Our ultimate goal is for our patients to go home and tell their friends everything went great,” Mitchell says. “Everything we do is patient-centric. We always ask, ‘Is this the best for the patient?’ Everything we do, we put the litmus test to it.”
Mitchell says he is quite proud of Premier for recognizing the importance of developing surgical leadership and setting up a quality initiative that is meaningful.
“We need thoughtful, knowledgeable, strong leadership so that when we say we do this well, it has meaning,” he says.
The doctors agree that the new building is sure to have a positive impact on the quality of the services Premier can provide. With all of the groups finally coming together in one place, they look forward to moving to this hub location in the middle of Knoxville. They expect the centralized location will streamline the patient experience and help patients get better faster.