100 Years of inspiring quality at the ACS: how did we get here? Journal of Pediatric Surgery Lecture.

Throughout its 100-year history of working to ensure that surgical patients receive safe, high-quality, cost-effective care, the American College of Surgeons has adhered to four key principles: (1) Set the standards to identify and set the highest clinical standards based on the collection of outcomes data and other scientific evidence that can be customized to each patient's condition so that surgeons can offer the right care, at the right time, in the right setting. (2) Build the right infrastructure to provide the highest quality care with surgical facilities having in place appropriate and adequate staffing levels, a reasonable mix of specialists, and the right equipment. Checklists and health information technology, such as the electronic health record, are components of this infrastructure. (3) Collect robust data so that surgical decisions are based on clinical data drawn from medical charts that track patients after discharge from the hospital. Data should be risk-adjusted and collected in nationally benchmarked registries to allow institutions to compare their care with other providers. (4) Verify processes and infrastructure by having an external authority periodically affirm that the right systems are in place at health care institutions, that outcomes are being measured and benchmarked, and that hospitals and providers are proactively responding to these findings.