Quality of care is defined by the World Health Organization (WHO) as “the extent to which health care services provided to individuals and patient populations improve desired health outcomes.” According to the WHO, in order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centered.
In addition, it should be value-based care, in which the focus on patient care shifts from quantity to quality. For the clinician, the focus must be healthcare outcomes rather than the number of patients attended to during a working day. For the patient, quality care should be provided when needed, in an affordable, safe and effective manner. The patient should be engaged and involved in their own care, so that they take ownership in preventive care as well as in their treatments. As the Agency for Healthcare Research and Quality states, quality in health care is defined “as doing the right thing for the right patient, at the right time and in the right way to achieve the best possible results.”
A Centre of Excellence (COE) is a team that brings together people from different disciplines and provides shared facilities and resources, as well as leadership, best practices and research, focusing on support and/or training. Since its inception in the early 1950s, bariatric surgery has undergone amazing changes. Over the years, it has experienced important changes, focusing on practices that could improve its outcomes. Since 2003, the Surgical Review Corporation has been focusing on practices that promote patient safety and lead to excellent short- and long-term outcomes. Bariatric surgery programs that enable these practices have been designated as bariatric COE.
There are many steps that lead to achieving the best quality of care in bariatric surgery. Selection criteria must be defined and assessment of potential patients must improve, and this cannot be done without a multi-disciplinary team approach. Operative experiences must also improve by achieving better anesthesia, surgeons’ training and by establishing standardized clinical pathways such as the ERAS programs. Data collection and analysis of outcomes should not be forgotten.
Becoming a COE in bariatric surgery is a standardized system of accreditation. It should be based on 3 factors: surgeon leadership, a multidisciplinary approach to bariatric surgery and reporting outcomes to a national database. Achieving some form of excellence in a bariatric practice would lead to having successful outcomes for our patients. In our commitment to quality of care we aim to provide a comprehensive approach to the management of patients with adiposity-based chronic diseases, and we need to deliver high quality services to all patients, with politeness, excellence, compassion and competence. If we are able to provide patients with excellent quality of care we will be able to achieve successful outcomes for our patients.
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