Resistance to Change From Super Performers: The EQI, Ego, and the Safety Card

We congratulate Merritt and colleagues 1 Merritt R.E. D’Souza D.M. Abdel-Rasoul M. et al. Analysis of outcomes for robotic-assisted lobectomy with an enhanced recovery after surgery protocol. Ann Thorac Surg. 2023; 115: 1353-1360 Abstract Full Text Full Text PDF Scopus (1) Google Scholar for shining a light on how we can all get better and improve our patients’ outcomes. Our goal is to provide our patients with the highest quality of care, at the lowest cost, with the best patient experience, to maximize our value. These factors are all measurable and improvable. If we all agree that minimally invasive is better, shorter length of stay is better, less invasive is better, and fewer complications are better, then this study shows we all can do lobectomy with a 3-day length of stay. Yet, there remains much room for improvement. If one can do it, so can all. Our current divisional goals are to do every lung resection (pneumonectomy, lobectomy, and segmentectomy) robotically, for all patients to have a 23-hour length of stay, have no 30 or 90-day mortality, and maintain major morbidity under 4%. 2 Geraci T.C. Chang S.H. Chen S. et al. discharging patients by post-operative day one after robotic anatomic resection. Ann Thorac Surg. 2022; 114: 234-240 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar How did we get here? How do you get a room full of superperformers to agree to improve and change and not hide behind their egos, the “safety card,” and/or their “comfort level”? The answer is leadership and leveraging meaningful accurate data. The Efficiency Quality Index (EQI) is a total score of metrics composed of accurate and vetted data that measure true surrogates of quality, cost, outcomes experience, and citizenship. 3 Cerfolio R.J. Chang S.H. Efficiency Quality Index (EQI)—implementing a novel metric that delivers overall institutional excellence and value for patients. Front Surg. 2021; 7: 604916 Crossref PubMed Scopus (5) Google Scholar Analysis of Outcomes for Robotic-assisted Lobectomy With an Enhanced Recovery After Surgery ProtocolThe Annals of Thoracic SurgeryVol. 115Issue 6PreviewThe impact on cost relative to clinical efficacy of enhanced recovery after surgery (ERAS) protocols for patients who undergo robotic-assisted lobectomy is currently unknown. The objective of this study was to compare cost and perioperative outcomes of robotic-assisted lobectomy before and after implementation of an ERAS protocol. Full-Text PDF