Defining and Measuring Quality in Colorectal Surgery

Kristen Ban, MD, MS

Rebecca Gunter, MD, MS

Arielle Kanters, MD, MS

Over the past 20 years, there has been a growing focus on quality and safety in both medicine and surgery. Many argue that this was ignited in 1999 following the publication of To Err is Human: Building a Safer Health System, which highlighted that up to 100,000 deaths per year could be attributed to preventable errors in health care delivery.[1] Coupling this with the unexplained variation in care across regions[2] and publicly reported patient outcomes, researchers have prioritized identifying actionable opportunities for improvement. To make improvements, however, we must first be able to define quality.

The Institute of Medicine (IOM) defines quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”[3] More specifically, the IOM identifies the domains of quality as—effectiveness, efficiency, equity, patient centeredness, safety, and timeliness. These domains are broad, and their outcomes are varied. As such, there is not a single tool or strategy that can be used to measure success in this field.

To help surgeons navigate the challenges of not only defining but measuring quality, we have brought together a diverse group of authors to contribute to this edition. They are experts in their field and have dedicated their academic careers to finding opportunities to ensure consistency in the quality of care delivered to patients. We are grateful for the time each of them has spent on this work and their efforts to furthering the science of quality improvement. Here, we hope to provide an overview of the many ways in which quality can be addressed—on the patient, surgeon, or institutional levels, and the tools available to help measure the success of an intervention, both quantitatively and qualitatively. Perhaps this will inspire readers to explore their own opportunities for quality assessment and improvement, and we can all help further the goal of delivering high-quality care to our patients.

We would like to thank Dr. Steele for the opportunity to share this work. We are honored to serve as guest editors, and hope that this edition helps shed some light on the challenging topic of quality.

Publication History

Article published online:
13 March 2023

• References

• 1 Kohn LT, Corrigan J, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington (DC):National Academies Press. 2000. PMID: 25077248
• 2 Birkmeyer JD, Sharp SM, Finlayson SR, Fisher ES, Wennberg JE. Variation profiles of common surgical procedures. Surgery 1998; 124 (05) 917-923
• 3 Patient Safety and Quality Measures. Agency for Healthcare Research and Quality. Accessed on December 4, 2022 at: https://www.ahrq.gov/patient-safety/quality-measures/index.html