Washington State's approach to variability in surgical processes/Outcomes: Surgical Clinical Outcomes Assessment Program (SCOAP)

Abstract

SURGEONS AND other stakeholders in healthcare share the perception that there is significant variation in both the outcomes of surgical care and the processes used to achieve those outcomes among hospitals and surgeons. Industry has long recognized that variability in process and performance is a threat to the quality of its products and has devoted considerable effort to the management and containment of this phenomenon. Working together with industry, regulatory groups also play a role in addressing variability. For example, while there is significant variation in aviation safety around the world (Fig 1), in regions where there are strong relationships between regulatory groups and industry sponsored safety programs these adverse outcomes are minimized and public confidence has been assured. In the United States this confidence comes in part from the longstanding oversight activities of the Federal Aviation Association (FAA). Through its use of a ‘‘complete’’ surveillance system and by regulating performance ‘‘outliers’’ the FAA and the aviation industry have limited the impact of this variability. There is no FAA for surgery, and while there will always be variability in surgical care, the perception of widespread gaps in surgical quality between centers