Mark Chassin, M.D., regularly points out that thorny patient safety issues have many causes of failure — "not just three or four, but most often 10, 15, 20, 25." As the head of the Joint Commission told us earlier this year, each of those failures has a specific intervention that needs to be "targeted to it."


So, it shouldn't come as a big surprise that the Joint Commission's Center for Transforming Healthcare's latest patient safety initiative unearthed upward of 34 risk factors for colorectal surgical site infections, including patient characteristics, surgical procedure, antibiotic administration, preoperative, intraoperative and postoperative processes, and measurement challenges.

Seven hospitals participated in the two-and-a-half year initiative, and the center collaborated with the American College of Surgeons in not only gathering key data elements, but also developing targeted solutions. Overall, the seven hospitals reduced SSIs by 32 percent, saving more than $3.7 million, Chassin said during a press call yesterday.

Chassin emphasized that robust process improvement, which he says is the linchpin to the center's approach to patient safety, was the driving force in reducing SSIs in this project.

"This has been a problem surgeons have been struggling with for years," he said. "We've tried simple answers — here are the three things everybody ought to do, here are the five things or the 10 things." In the end though, there are far too many complicating factors, each deserving of its own solution, he reiterated during the press call.

It is also key to attack these problems with multidisciplinary teams, said Shirin Towfigh, M.D., director, medical student education program and attending surgeon at Cedars-Sinai Medical Center. And, she added, to provide positive feedback to clinicians as you embark on process improvements. The Los Angeles hospital averages 45 colorectal surgeries a month. Towfigh said that 46 surgeons were involved in the initiative. The team met with each surgeon individually and developed specific action plans tailored to the surgeon's care patterns.

"There's no magic bullet," she said, adding that they also got tremendous cooperation from nurses and executive leadership.

The center will add the strategies employed in this initiative to its Targeted Solutions Tool, which enables Joint Commission accredited hospitals to mirror best practices.