In this episode of BackTable Urology, Dr. Jose Silva interviews Dr. Peter Steinberg, director of quality and safety in the Division of Urology at Beth Israel Deaconess Medical Center, about practical tips and his personal experience in improving quality and safety.

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SHOW NOTES

First, Dr. Steinberg explains how he found quality and safety as his niche in academic medicine. He was named in a malpractice lawsuit as a resident, which encouraged him to think about safety and complications in OR. Furthermore, he became interested in root cause analysis at his institution and discovered that he was skilled at improving the efficiency and results of a process.

Next, he and Dr. Silva define and discuss quality, which they agree is delivering safe and effective outcomes in efficient time and lower cost to patients. Quality includes getting rid of waste processes, such as patients waiting for too long, not utilizing physician talent, extraneous movement within a system, and extra steps in a process in general. Dr. Steinberg explains that although surgeons already think in an efficient and high quality manner, they are underrepresented in quality and safety discussions. If solutions are simple, he encourages members of a healthcare team to deal with issues themselves or within their direct teams. For bigger problems with more complex solutions, challenges arise if higher administration needs to get involved to implement solutions. However, he gives a few tips for speaking with administration, such as speaking administrative language and performing an impact effort matrix to find high impact projects with low effort. Additionally, he shares acronyms for quality improvement projects, like SMART goals (specific, measurable, achievable, relevant, timely) and PDSA cycles of improvement (plan, do, study, act ).

Next, he defines safety as the process of minimizing errors in order to meet a promised standard of care. Safety events can include preventable harm, adverse events, and near misses. Some big areas where safety may be compromised are medications, universal protocols, support staff and equipment, patient selection, use of techniques/maneuvers, and fire safety. To ensure the correct patient and side for operations, he encourages the use of two identifiers and time out procedures, even for in office procedures. He always reads labels and sticker labels for his medications. Furthermore, he encourages private practice doctors to engage in some form of M&M boards to categorize their complications, like in academic centers. Finally, he summarizes that safety issues are often systemic and undetectable instead of the result of a single action.

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