This article, titled “The Michigan Surgical Quality Collaborative: a legacy of Shukri Khuri“, describes the successful implementation and foundational elements of a regional quality collaborative in Michigan. Authored by Darrell A. Campbell Jr. and colleagues, the paper details the establishment, structure, and key initiatives of the Michigan Surgical Quality Collaborative (MSQC).
Key aspects of the article include:
- Partnership Model The MSQC is a collaborative effort involving 34 Michigan hospitals, the American College of Surgeons (ACS), and a major private payer, Blue Cross Blue Shield Michigan/Blue Care Network (BCBSM/BCN). It operates on a “pay for participation” model, meaning hospitals receive financial support for their involvement rather than for achieving specific performance outcomes, which helps reduce inter-institutional competitiveness.
- Foundation and Influence The collaborative is built upon the ACS National Surgical Quality Improvement Program (NSQIP) platform and is deeply rooted in the vision and legacy of Shukri Khuri, who championed standardized national outcomes metrics for surgical improvement. Khuri’s emphasis on collegial collaboration among surgeons and institutions to improve quality is a core principle of the MSQC.
- Unique Infrastructure The MSQC has a distinct infrastructure that supports information technology, collaborative efforts, and ad hoc quality improvement (QI) initiatives. Data are collected and analyzed by an administrative and analytic center at the University of Michigan, with quarterly meetings facilitating personal interactions and sharing of “best practices” among participants. The MSQC also uses a website, newsletter, and YouTube channel for communication.
- Quality Improvement Initiatives The article highlights several specific QI initiatives undertaken by the MSQC, including:
- A colectomy initiative that defined procedure-specific data elements and gathered over 2,000 cases to date.
- A myocardial ischemia initiative focusing on appropriate diagnostic strategies and postoperative care to reduce costs and variation in care.
- The development and evaluation of “Big 10” process measures aimed at strategic areas such as avoiding blood transfusions, maintaining normothermia, and achieving tight glycemic control for diabetic patients.
- Efforts to reduce surgical site infections (SSI) by identifying and disseminating “best practices” through site visits to high-performing hospitals and providing laminated boards for operating rooms.
- Outcomes and Advantages The article concludes that the MSQC’s regional structure accelerates the pace of surgical QI compared to the national program alone, largely due to faster data feedback (quarterly vs. semi-annual) and enhanced sharing of specific process measures and detailed “best practices”. The flexibility to innovate and rapid access to detailed data are also identified as crucial features.
Reference: Campbell, D. A., Jr., Kubus, J. J., Henke, P. K., Hutton, M., & Englesbe, M. J. (2009). The Michigan Surgical Quality Collaborative: a legacy of Shukri Khuri. The American Journal of Surgery, 198(5A), S50–S55.