ACS Quality and Safety Conference Celebrates 20 Years of Innovation

Each summer, the ACS holds its Quality and Safety Conference (QSC), a multiday meeting purpose-built to help surgeons and hospitals improve the quality of patient care they provide.

This year’s conference, planned for July 17–20 in San Diego, California, is the 20th anniversary of QSC. It also is a moment to appreciate how much the conference has achieved in 2 decades—and how considerably the College has developed its products and services to help advance quality in surgical care.

NSQIP and New Beginnings

The first QSC, held in 2005, came at the heels of another watershed event in the history of quality improvement: the establishment of the National Surgical Quality Improvement Program (NSQIP) as an ACS program in 2004.

NSQIP was founded in the late 1980s. The impetus was a then-new federal law that compelled the US Department of Veterans Affairs (VA) to show that its surgical outcomes were comparable with national averages. But the data on national averages did not exist at the time. So, the VA used its unusual position as a unified national healthcare system to gather data on various surgical procedures performed across its hospitals and then created a risk-adjusted, validated, peer-controlled database that tracks surgical outcomes.

This was a crucial step forward in surgical quality improvement. Quality programs have developed enormously since the inception of NSQIP, but using databases to measure and compare surgical outcomes remains central to this work.

NSQIP quickly showed remarkable objective benefits. Within the VA, the 30-day postoperative mortality rate dropped by 47% and morbidity by 43% between 1991, just before NSQIP was in use, and 2006.¹

Such a successful, innovative program was not destined to remain siloed within a single healthcare system. In a highly cited paper published in the Annals of Surgery in 1998, influential surgeon Shukri Khuri, MD, FACS, and coauthors explained that wider use was the goal. “NSQIP is interested in collaborating with the affiliated non-VAMC [Veterans Administration Medical Centers] surgical services to implement similar programs and compare surgical outcomes between VHA [Veterans Health Administration] and other nonfederal hospitals.”²

At the time of that publication, a version of the idea already was being realized. By the turn of the millennium, NSQIP had been piloted successfully in 18 private hospitals.³

By 2004, the entire database had shifted from the VA to the ACS, where it has remained ever since. This move made it possible to begin to grow NSQIP from a few hospitals to more than 700 sites today (including, despite the program’s name, more than 100 international sites in Europe, Australia, and the Middle East). This effort in turn necessitated practical assistance for the many participating hospitals—and hence QSC was born.

Networking and Soft Science

The original name of QSC was “the NSQIP Conference.” Then, as now, hospitals that joined NSQIP received reports detailing their performance relative to other healthcare institutions and to set standards of care. Those hospitals, some of which were new to quality improvement, needed insights into how to read those reports accurately, understand the meaning of underlying statistics, and use that information to change practices where needed and ultimately give higher-quality surgical care.

“It started as a small idea of getting people together to talk about quality and share how to improve,” said Clifford Y. Ko, MD, MS, MSHS, FACS, Senior Vice President of the ACS Division of Research and Optimal Patient Care. “It was probably one of the first quality improvement collaboratives in surgery from hospitals across the nation.”

Eschewing a top-down model, the conference was based on networking between healthcare institutions. Dr. Ko explained, “When hospital administrators said, ‘Oh, I’m not as good as I want to be in X, Y, or Z,’ and was in the same room as hospitals that were really good in X, Y, and Z, they could say, ‘How do you guys do it?’”

The advice that hospitals could give each other helped inform the improvements each might make. “No hospital was great at everything, and no hospital was terrible at everything. So sometimes hospitals were learning from other hospitals and teaching other hospitals, all at the same time," he said.

The diverse range of hospitals at the meetings meant that all could find another facility struggling with the same problem and engage in networking during and after each meeting. These collaborations facilitated hospitals adopting the successful methods used by others or avoiding the pitfalls that had affected similar institutions, facilitating faster improvements in patient care.

This collaboration provided a crucial bridge over a gap between the data that NSQIP provided and the action necessary to make data insights meaningful. As Dr. Ko said, “To achieve high-quality, optimal care data are essential but insufficient. You still need to act on the data.”

Art of Implementation

Leveraging insights from data was an area to which the ACS could bring its expertise.

The College had long been involved in quality improvement in hospitals. Within a few years of its 1913 founding, influential surgeon Ernest A. Codman, MD, FACS, had articulated his “end result idea,” a concept later echoed in the impetus for and design of NSQIP. Dr. Codman described the idea as “the common sense notion that every hospital should follow every patient it treats, long enough to determine whether or not the treatment has been successful, and then to inquire, ‘If not, why not?’ with a view to preventing similar failures in the future.”⁴

He pursued quality improvement via his Hospital Standardization Program, an ambitious effort to help early surgical wards deliver better care. The program began in 1919, endured for decades at the ACS, and spun off as an independent entity, now called The Joint Commission, in 1951. This organization continues to accredit hospitals and hospital programs nationwide that meet their quality standards.

Separately, the ACS was advancing cancer care through the Commission on Cancer, which in the 1930s began offering accreditation to cancer centers that could deliver optimal care. In 1987, the ACS Committee on Trauma established its Verification, Review, and Consultation Program, with site reviewers visiting hospitals to help them carry out quality efforts. Both programs focused on implementing specific standards in surgical care, rather than simply collecting the data that could make the existing quality of a facility clear.

By the time QSC launched 2 decades ago, the ACS had accumulated insights into how to ensure a quality improvement effort involved not only the right data and standards, but also the right leadership, staff involvement, focus, insights, framework, and momentum to succeed.

The skills behind implementation, although sometimes misunderstood or underrated, are crucial to master. “Some people think that if you just show people that they’re bad, they’ll get better,” Dr. Ko said. “Some people will, but most people will not know how, or if it’s a team effort, the team needs to be coordinated on how to go from A to B all in the same way. Otherwise, if people do it differently or at different speeds, and it’s not coordinated, it’ll be poor.”

As a result, QSC has evolved to offer a wide range of sessions that also aim to facilitate the skills in change management, leadership, and team engagement that make quality improvements possible. This programming includes instruction on specific methods, such as the Plan-Do-Study-Act cycle and Six Sigma process improvement methodologies, as well as insights derived from so-called soft sciences, such as behavioral economics and cognitive psychology.

Helping Bariatric Surgery Become Safer

Over time, QSC built on these elements to further extend its impact. The conference has become an annual opportunity to identify new opportunities to conceptualize, initiate, or grow Quality Programs.

In 2012, the ACS launched the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) in collaboration with the American Society for Metabolic and Bariatric Surgery. The program immediately began participating in QSC, according to Program Manager Lisa Hale, MSN, RN, CNOR(E), CPHQ, CBN, who has been part of the program since its inception.

“QSC serves as a crucial platform for MBSAQIP to present findings and discuss innovative quality improvement strategies,” Hale stated.

She credited it with “fostering collaborations and partnerships among centers to address systemic issues and promote widespread adoption of best practices,” which was one piece of a critical shift that has helped move bariatric surgery from a surgical procedure with a relatively high level of risk to one safer than hip replacement and gallbladder removal procedures.⁵

Safety in bariatric surgery already had started improving before the launch of MBSAQIP, Hale said. “However, MBSAQIP significantly accelerated and sustained this advancement through standardized data collection, evidence-based guidelines, and structured accreditation requirements”—all of which have been presented, discussed, and refined during QSC meetings.

Improving Geriatric Surgery

In 2019, the ACS Geriatric Surgery Verification (GSV) Program was launched after QSC attendees identified the need for it.

“As we started to get data in geriatric surgery, we knew that older adults undergoing surgery had higher untoward event rates, higher rates of occurrences of safety-related issues or quality issues,” Dr. Ko explained. “We got people together. The sessions were full. People were always talking about what we should do. We had geriatricians come in and speak.”

As a result, “People said, ‘Why can’t we have a dedicated effort to this?’ So, that helped open our eyes to the need for a Geriatric Surgery Verification Program.”

The GSV Program now enrolls hospitals and, in part through in-person visits, requires that they implement six standards designed to ensure geriatric patients undergoing surgery receive evidence-based best practices for optimal outcomes in this age group, such as geriatric vulnerability screens.

The program has gained traction. In August 2024, the US Centers for Medicare & Medicaid Services adopted the Age Friendly Hospital Measure, which specifies standards for high-quality care for elderly patients. The measure aligns with the GSV and came into effect on January 1, 2025—and the ACS, which advocated for the measure, stands ready to help hospitals meet it.

Based on current progress, the ACS will have as many as 100 hospitals verified in the GSV Program by the end of the year.

Influencing Pediatric Care

The annual meeting, originally created to facilitate the use of NSQIP, has also influenced a major expansion of NSQIP. The involvement of pediatric surgical teams in QSC led to the realization that the quality improvement available to adults also should extend to children. As a result, the ACS launched NSQIP Pediatric, a database that parallels the original, adult-specific NSQIP with a focus on children’s surgical procedures.

Recognizing that positive change requires more than data, the launch of ACS NSQIP Pediatric in 2016 came alongside the introduction of the Children’s Surgery Verification (CSV) Improvement Program. This program helps hospitals attain quality standards in pediatric surgery.

Research examining the program underscores its benefits. In 2017, an article published in the Journal of the American College of Surgeons identified NSQIP Pediatric as a useful addition to a pediatric surgical department—capable, among other things, of identifying morbidity far more comprehensively than a traditional morbidity and mortality conference could.⁶

In 2022, an article comparing pediatric femur fracture care found that hospitals verified by the CSV Program had shorter mean time to surgery (by 4 hours), shorter hospital length of stay (by a day and a half), and less narcotic use (by 39%).⁷

Expanding Internationally

One of the most intriguing developments related to QSC was perhaps the most unexpected.

According to Dr. Ko, “About 10 or maybe 12 years ago, these surgeons from Japan said, ‘We want to join this group because it’s so great. Can you translate it into Japanese?’ And very early on, we said, ‘No, we can’t, but we’ll help you develop your own.’”

The ACS assisted this group to develop a Japanese database of surgical outcomes—conceptually based on but fully independent of NSQIP. About 3 years ago, the College helped a Korean group of surgeons pursue the same goal.

The 20th anniversary QSC meeting will include four nations—the US, Canada, Japan, and Korea—discussing ways to learn from each other, despite differing cultures and payment systems.

Continuing to Grow

As its 20th anniversary approaches, QSC continues to grow. This year, the conference received 1,100 abstract submissions, an all-time high. Of these, 110 have been selected for podium presentations, and many more for poster sessions.

In 2026, the conference will see another expansion, as the ACS Cancer Conference—long a freestanding event—will be folded into QSC, offering those interested in quality improvement in cancer care optimal benefit under a single registration. In addition, the conference aims to include a greater number of participants focused on anesthesiology—thus encompassing quality across the surgical team to a greater extent.

Alongside changes to the meeting itself, the ACS is adding improved public reporting to the ACS website, which will offer patients and the public a searchable database showing which hospitals have achieved verification or accreditation via ACS Quality Programs. The goal is to allow these hospitals to capitalize on this hard-earned achievement, and more importantly, to help patients find hospitals where they can receive the highest-quality surgical care. The new Find a Hospital search launched earlier this month at facs.org/find-a-hospital.

Dr. Ko, who has written about the need to “improve the improvement,”⁸ sees little chance that QSC will slow down or veer from its core mission of improving surgical care. What stands out about the conference is somewhat like what remains notable about NSQIP, all these years after its inception, he says: “This is for surgeons, by surgeons.”

M. Sophia Newman is the Medical Writer and Speechwriter in the ACS Division of Integrated Communications in Chicago, IL.

References

1. McGory Russell M. The National Surgical Quality Improvement Program: Background and methodology. Seminars in Colon and Rectal Surgery. 2012; 23(4):141-145.
2. Khuri SF, Daley J, Henderson W, et al. The Department of Veterans Affairs’ NSQIP: The first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg. 1998;228(4):491-507.
3. American College of Surgeons. Quality Programs History. No date. https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/history/. Accessed June 1, 2025.
4. Brand RA. Ernest Amory Codman, MD, 1869–1940. Clin Orthop Relat Res. 2009;467(11):2763-2765.
5. Broderick RC, Fuchs HF, Harnesberger CR, Chang DC, Sandler BJ, Jacobsen GR, et al. Increasing the value of healthcare: Improving mortality while reducing cost in bariatric surgery. Obesity Surgery. 2015;25(12):2231-2238.
6. Cromeens BP, Lisciandro RE, Brilli RJ, Askegard-Giesmann JR, Kenney BD, Besner GE. Identifying adverse events in pediatric surgery: Comparing Morbidity and Mortality Conference with the NSQIP-Pediatric System. J Am Coll Surg. 2017;224(5):945-953.
7. White CR, Leshikar HB, White MR, White SR, Semkiw K, Farmer DL, Haus BM. Does the American College of Surgeons New Level I Children’s Surgery Center Verification affect treatment efficiency and narcotic administration in treating pediatric trauma patients with femur fracture?. J Am Coll Surg. 2022;236(3):476-483.
8. Ko CY, Martin G, Dixon-Woods M. Three observations for improving efforts in surgical quality improvement. JAMA Surg. 2022;157(12):1073-1074.