Technically speaking, Drs. Dale Mueller and Richard Anderson are competitors affiliated with different practices—HeartCare Midwest and Peoria Surgical Group, respectively. However, with their shared goal of providing the best patient care possible, they joined forces to create the OSF Saint Francis Thoracic Center of Excellence.

“Instead of hiding our data on variation in outcomes and retreating into competitive behaviors, we chose to work together to understand why we differed and to learn from each other how we might improve the entire process of thoracic surgery,” Dr. Mueller said. “We chose to pool our resources and have common ground on patient care.”

“Dale and I do the majority of the thoracic surgeries, and we felt that we could improve patient outcomes if we collaborated,” Dr. Anderson added.

This collaboration in the care of patients undergoing thoracic surgery, which is lung and chest surgery, involves a multidisciplinary team of healthcare providers, including physicians, nurses, advanced-practice nurses, physician assistants and respiratory therapists, with support from hospital administration.

Among the first measures taken in establishing this collaboration was standardizing clinical protocols and identifying one unit with expertise in this area where patients would be admitted post-surgically. A key to ensuring the success of this step was designating an advanced practice nurse trained in this subspecialty, Shannon Foiles, to play a major role in the care of these patients. “I’m very proud to be a part of this program,” said Foiles. “It’s easier for me to do my job because of this collaboration.”

“It could be difficult working with two different surgeons,” said Dr. Anderson, “but Shannon knows how we want things done, and she has really made this work. She is kind of the glue for us because she is here all day to set goals and make plans for the day.”

“The nurses have really taken ownership and pride in the care of these patients,” Dr. Mueller added.
Since its inception in 2003, the Thoracic Center of Excellence has expanded to include clinical research, publications, a patient education guide and video, education conferences, and collaboration with other institutions. Since 2006, the Center has been involved in an initiative to improve the quality of patient care by collecting outcome data to report to the Society of Thoracic Surgeons’ national database.

“This process and systems-oriented approach is the best way to raise the performance level of all thoracic surgery programs,” Dr. Mueller said. “It affirms the commitment of our specialty to excellence, and it should be the cornerstone of any quality improvement effort.”

The success of the Thoracic Center of Excellence is reflected in the fact that it ranks third in the country for risk-adjusted outcomes for major lung resections. According to Dr. Mueller, the collaboration “has demonstrated lower morbidity and mortality with a decreased hospital length of stay and decreased hospital cost” compared to the time prior to its introduction.

Other institutions participating in the national database include: 

• Mayo Clinic, Rochester, Minn.
• Duke Heart Center, Durham, N.C.
• Cleveland Clinic, Cleveland, Ohio
• Northwestern Memorial Hospital, Chicago, Ill.
• Massachusetts General Hospital, Boston, Mass.
• Rush University Medical Center, Chicago, Ill.
• Barnes Jewish Hospital/Washington University, St. Louis, Mo.
• University of Florida, Jacksonville, Fla.
• University of Chicago hospitals, Chicago, Ill.
• Cedars-Sinai Medical Center, Los Angeles, Calif.
• Yale-New Haven Hospital, New Haven, Conn.

While pleased with the success of the Center to date, Drs. Mueller and Anderson are striving for even better outcomes. “We continually look at our strengths and weaknesses to determine what we can do better,” Dr. Anderson said.

Added Dr. Mueller: “We want to be No. 1.” iBi