Dr. John Hwang

Dr. John Hwang, National Surgical Quality Improvement Program (NSQIP) Surgical Champion, Royal Columbian Hospital, fostered a patient-participation approach to improving post-surgical outcomes that has seen results.

Dr. John Hwang is a bit of an enigma – he’s a general surgeon who doesn’t do surgery and a hospital physician whose mission is to send patients home.

That’s because, as Royal Columbian Hospital’s National Surgical Quality Improvement Program (NSQIP) surgeon champion, he helps surgical teams reduce complications and enhance post-operative patients’ recoveries so they can be independent at home sooner, which reduces the burden of long stays on the system.

Dr. Hwang was destined to be a doctor. He was raised in Calgary in a medical family – his father and uncle were both physicians and all three of his siblings graduated medical school. So when he first joined Fraser Health in 2010, it was as a surgical locum, performing surgeries at Chilliwack, Burnaby, Surrey and Delta hospitals.

Yet by 2013 he moved out of the operating room and into data-driven health care innovation as Royal Columbian’s NSQIP champion. Staring at the numbers, he faced a conundrum. While past quality improvement efforts showed initial gains, over 10 years, numbers reverted to the mean.

“Royal Columbian is a big hospital and we can see a lot of complications, because we do such complex surgeries,” explained Dr. Hwang, who is also the physician lead for the complex wound healing clinic at Jim Pattison Outpatient Care and Surgery Centre. “Yet something you notice is that the quality improvement numbers never really change, and I wondered why.”

He found the key at a conference in the U.S. where he learned front-line engagement and employee-driven quality improvement delivered longer term success.

So in 2015 he set out to reinvent quality improvement at Royal Columbian. He collaborated with Fraser Health executive, Organizational Development, the surgical quality team, and the hospital foundation to create a set of surgical check-ins, workshops for frontline employees, and an annual surgical research day event. Employees generated their own quality improvement initiatives with quality improvement grants from the foundation and NSQIP data was made more accessible and actionable for care providers.

Darlene Mackinnon, Executive Director for Royal Columbian Hospital, praised Dr. Hwang as “an exemplary leader who goes above and beyond in his strides to engage employees and physicians in quality improvement initiatives for enhancing patient care.”

Now, this surgeon and his team are placing a stronger focus on patient experience as a driver for change. With data in hand, they are beginning at the bedside: asking patients themselves what could help them recover more effectively after surgery.

“We start with the patient experience,” Dr. Hwang said. “We develop relationships with our patients, our nurses, our frontline employees and we ask them what is going well that we can duplicate and what is not going well that we can improve. You gauge success on whether patients say their experience is better. If you can improve their experience, then the numbers usually improve.

The team has used this method with vascular surgery patients, who were staying in hospital for weeks to a month more than the standard three to five days, and sometimes returned with infections or complications. Nurses identified the issue was that patients didn’t feel secure enough to recover at home. So the nursing team’s #Sendmehome project created an educational discharge package for patients, complete with hand sanitizer, numbers to call if something goes wrong, and follow-up phone check-ins that nurses stayed after their shifts to complete.

These initiatives helped promote safe discharges, while operational changes, including the hiring of a nurse practitioner and creation of a vascular wound outpatient clinic contributed to the work. The result? Average length of stays are down significantly – from a high of approximately 20 days in January 2017 to 4.5 days in July – and hospital management is convinced they will stay there.

“He has changed the culture on my surgical units and has inspired my managers and frontline employees to make quality improvement a part of their daily work,” agreed Barb Sutherland, Royal Columbian Hospital’s Clinical Director for Surgery. “He will not be satisfied until we have no hospital infections.”

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