Dr Pierre Guy: Using data to provide quality surgical care

December 17, 2019

MSPQIDoctors of BC, the BC Ministry of Health and health authorities representatives are working to develop a Measurement System for Physician Quality Improvement (MSPQI). The goal is to provide aggregated data to assess overall health system performance and to have physicians reflect on their own data that is relevant to their practice, that is easily accessible and that will improve care or confirm good care. 

In the initial phase, the MSPQI Steering Committee has created two Quality Measures Group to support this work – the Surgical and Procedural Care group and the Primary Care group. The two groups have submitted their initial measures as recommendations to the Committee, which oversees this collaboration and makes final recommendations.

The Surgical and Procedural Care group is now looking to refine the technical aspects of these initial measurements in collaboration with the MSPQI’s Technical Workgroup. In addition, the Surgical workgroup will reach out to select surgical sections to validate the initial measures and explore additional measures specific to these sections. 

Dr Pierre Guy, who chairs this group, says “this is an iterative process – I would call the first set of measures we submitted ‘generic’ because they apply to all surgical specialties – but we need to develop measures with input from individual surgical specialties that are relevant to them.”

The following is an interview conducted with Dr Guy to discuss this work and why he feels it’s important to everyone involved with health care.

Q. Why is this work important to you?

To me, it’s an exciting time. This is really an opportunity for us to demonstrate the value of the care being delivered in BC. Many quality improvement projects have happened across the province affecting the care of surgical patients. I was personally involved in the provincial Hip Fracture Redesign project with Dr Ken Hughes. MSPQI is an opportunity to bring this expertise together and build on it. We have people who are interested on the clinical side, on the administrative side and as patient representatives to come and talk about measuring the quality of surgical care for the people of BC.

Q. How did you develop your recommendations?

We started with using the BCPSQC’s BC Health Quality Matrix and the Health Quality Ontario Criteria for Selection as our foundation. Additionally, some of the recommended measures came from previous work conducted for PSEC (Provincial Surgical Executive Committee). So, we built on this to analyze, validate and make it relevant to surgical care delivery. Although we have submitted our recommendations – realistically, this is a long-term process that can even change as health care changes. 

I think that, more and more, people want decisions based on data, but we have to be careful that the data we use, the choices we make and the measurements we want are reliable and relevant. We want the data to actually be giving us the information we want and need. 

Q. How was the patient voice heard during this process?

We were lucky to have a patient partner in our group who was well-versed to committee work. She has really added value through her concise questions, her ability to contribute – all of which combined to help move things forward. We’ve been fortunate.

Q. What physician concerns have you heard expressed about this initiative?

There were a number of concerns expressed such as is “Big Brother” watching? Will the tool be used in a punitive way? Will this add more work to my already busy schedule? All valid questions. Doctors of BC was quite clear before they became involved that the system will not be punitive or have a negative impact. Also, it’s stated in the Terms of Engagement that it wouldn’t cause additional work for physicians.

We are working to create an environment so it is easier for physicians and health care providers to improve the quality of the work. People are busy – so it’s more efficient to automate this data collection. At this point, we just want physicians to look at the information and see if it is applicable, relevant and will be helpful to them – and what improvements might be considered. Perhaps it will make it easier for a physician to approach their group or a hospital about improving an aspect of care.

When I presented the current work to the BC Orthopedic Association, they saw it as an opportunity to show the good that comes from surgery – we are confident we are improving the lives of individuals – so it’s great to quantify that and demonstrate the value of the care that we give.

Q. Anything you’d like to add?

You can tell by my excitement there are a lot of opportunities for improvement and we really share that excitement within our group – we find it a big step forward and people are committing their time – it’s a great committee to work with. Because everyone in this group has done quality work before – they know how difficult that is. We know we have to commit to carry on improving - the work is ongoing.

In addition, it’s a tremendous opportunity to have The Ministry of Health’s data available to use and linking the data using our own systems. This can actually inform us on the journey of a patient through the system. If we were a business with this amount of information, we would be using it constantly to try and improve our processes.

This is an amazing commitment by the BC government, health authorities and Doctors of BC and a huge step forward. We’re moving ahead – some of this has been done in other provinces but not to this extent or as collaboratively.

Q. Why is it important for physicians to be involved and how do they do that?

This tool is being developed to support physicians in their practice, to validate the care provided and identify ways to make improvements. If the physician voice is missing or is not as robust as it could be during the creation of these measures - then the value of these measures could be diminished. The data collected must be relevant to a wide variety of physicians and specialty areas, this requires collaboration and feedback from many. As MSPQI progresses, we will be reaching out to you through your sections and divisions to gather input. In the meantime, if you have any questions, please contact:

Brett Hodson, Director
Measurement System for Physician Quality Improvement
BC Patient Safety and Quality Council