Clinical Excellence Means Always Improving

By most nationally collected metrics available, US Acute Care Solutions is at or near the top in terms of emergency medicine quality. We know this by comparing our sites to our peer groups in the largest repository for emergency medicine national clinical quality metrics: the Clinical Emergency Data Registry (CEDR) of the American College of Emergency Physicians. We also rank very highly in operational metrics as measured by the Emergency Department Benchmarking Alliance (EDBA), whose Vice President is the Chair of our National Clinical Governance Board, Dr. James Augustine.

Participation in these groups is voluntary, which suggests that they actually skew toward higher quality sites, as those are the ones more likely to share their data. Considering that, our site clinicians should be proud of their work. Whether it’s reducing overall length of stay or door-to-discharge times, USACS sites as a group consistently rank above national averages.

However, it is entirely likely that if I told that to one of our physicians or APPs, their response would be: that’s not what I care about. Instead, they’d say, “I understand that I provide fast and efficient care. But what I want to know is, do I provide superb care?”

CEDR and EDBA track metrics related to time: how long do patients spend in the ED before being discharged? Or the same metric, but with the data sliced by size of ED, type of patient, etc. Those are worthwhile indices to track, but our clinicians, to their enduring credit, are more interested in whether they are providing accurate, precise care with quality outcomes.

Given the limitations of clinical data availability, the answer to that question is much more difficult.

Good Substrate

Perhaps the most important ingredient from a clinical quality perspective is starting with good substrate. In that regard, USACS is again ahead of its peer groups.

The physician groups that came together over the past three years to form US Acute Care Solutions were all of extremely high quality. That crucial fact has gone a long way to set the tone for our organization. There were challenges, of course. Integrating so many groups over such a short time was not an easy task.

Yet the groups that joined us were the ones most interested in retaining a voice over their future. They were the ones who believed what we do, which is that if you want to ensure that leadership is devoted to clinical quality, then ownership matters. These were not the clinicians who wanted to simply sell their practice to the highest bidder and then walk away from decision-making. Instead, these were the clinicians who wanted to continue to deliver the best care possible. As healthcare continued to consolidate, these were the clinicians who wanted to ensure their voice would continue to be heard.

Together, these groups brought amazing quality programs to USACS. Part of our task over the past two years has been to scale what was once local to now be national. One partner group brought the nation’s premier Observation Care program. Another brought our now ubiquitous Failsafe program, which has proven incredibly effective at reducing risk and avoiding bad outcomes for our patients. Yet another used their own actual clinical data and instituted innovative risk educational processes (led by Dr. John Bedolla, our National Director of Risk) that resulted in better patient outcomes. Across our company, these programs and others have been integrated and scaled upward.

ESQUIRE

As a group, we have embraced the theory that clinical excellence can only come from continued improvement from engaged clinicians over time. That is our task now moving forward.

As Chief Medical Officer, I see my role as guiding that progress across six areas:

• Education
• Safety
• Quality
• Innovation
• Risk
• Experience

Together, the acronym for these areas is ESQUIRE, a term I coined shortly after becoming CMO. Outstanding clinical leaders from across our group are leading the development of these programs on a national scale.

Perhaps the ESQUIRE sphere where we’ve made the most innovative strides is in education. We are fortunate to have two educational stalwarts: Dr. Joan Kolodzik, a lifelong clinical teacher and administrator who leads our CME division with effective and economical courses held throughout the country, and Dr. Jestin Carlson, a grant-funded educational investigator who leads our Clinical Education division with innovative educational processes like brief, targeted podcasts for on-demand education. These two leaders combine their unique skills to create what I am confident in calling the nation’s best post-residency educational program in emergency medicine.

Our Next Challenges

Our two biggest upcoming challenges are to establish robust clinical data capabilities to be able measure our quality improvement efforts and to take our excellence in emergency medicine and replicate ESQUIRE across our other specialties. The first requires us to partner with our hospital systems to gather data and measure the effect of our clinical management tools, educational podcasts and conferences, and quality reviews. Clinical data can be difficult to abstract and analyze, but our quality team led by Dr. David Klein is ready for the challenge as he works closely with our informatics teams led by Chris Lynn and Sue Brown.

USACS’ Integrated Acute Care program, which combines emergency medicine and hospitalist services under a single, accountable team, has seen extraordinary growth over the past year. We expect this pace of growth to accelerate and we in the CMO team need to support this through our ESQUIRE efforts.

As we have grown, we have added clinical capability in critical care, pediatrics, obstetrics and more. In addition to developing ESQUIRE in these specialties, I want to blur traditional divisions of care delivery to create higher quality and incur lower cost.

Most of us at USACS were trained in emergency medicine. One hard lesson many emergency medicine groups had to learn over the past few years was that their success as clinicians depended on expanding their concept of care outside the four walls of the emergency department. We must now take that same approach to healthcare as a whole. Just because we were trained in certain specialties does not mean that we must continue to think of ourselves purely in that sense. As a group now housing several specialties beyond emergency medicine, we must think of ourselves as one team devoted to one purpose: caring for patients no matter where they are.

An Iconoclastic Mindset

I must admit I have a strong affinity for iconoclastic thinking. I was raised in Montessori schools. I’m the son, grandson, and nephew of Montessori schoolteachers. Iconoclasm and the ability to learn independently are the main principles of a Montessori education. We are challenged to break down ideas that have been accepted over time, to innovate, and to free ourselves from institutional thinking that is too rigid or not grounded in fact.

These are some of the challenges we need to embrace in order to continue to evolve and improve care. Thankfully, I am joined by outstanding colleagues, in a group that is by its very structure built to support clinical innovation. Innovation requires both expertise and hard work, and a recent addition to our team will help augment these traits. Dr. Jesse Pines, the premier health services expert in emergency medicine, will join USACS in September as our National Director of Clinical Innovation. Dr. Pines will help our clinicians develop and analyze innovative programs to help stay ahead of the game in this rapidly changing healthcare landscape.

As we follow that path, I invite all my colleagues at US Acute Care Solutions to bring their ideas, give me their feedback, and shoulder the real work of continued, always-improving excellence. My door is always open. I freely give out my cell phone number. I will answer my phone. I will respond to your emails.

As a national group built on the foundation of physician ownership, we are the most well positioned to lead the nation in the spheres of ESQUIRE. The opportunities are enormous. The greatest physicians throughout history—Hippocrates, Galen, Rhazes, Avicenna, Pasteur, Lister, Osler, Apgar, and others—have always striven to take better care of patients than everyone else through innovation and determination. We at USACS must stand on the shoulders of these giants and do the same. Our patient care mission demands nothing less.