• Darrell A Campbell, James J Kubus, Peter K Henke, Max Hutton, and Michael J Englesbe.
• Department of Surgery, University of Michigan, MI, USA. darrellc@med.umich.edu
• Am. J. Surg. 2009 Nov 1;198(5 Suppl):S49-55.

BackgroundFrom the legacy of Shukri Khuri, we have successfully implemented a regional quality collaborative in Michigan, the Michigan Surgical Quality Collaborative (MSQC).MethodsThe MSQC represents a partnership between the American College of Surgeons (ACS), 34 Michigan hospitals, and a large private payer. It is based on a "pay for participation" rather than a "pay for performance" model. Although based on the ACS National Surgical Quality Improvement Program (NSQIP) platform, this collaborative has a unique infrastructure for information technology, collaboration, and ad hoc quality improvement (QI) initiatives.ResultsSpecific initiatives have been implemented with colectomy, myocardial ischemia, and surgical site infection (SSI). Based on these initiatives, best practices have been implemented. Adherence to these best practices is modest, but despite this, there has been significant QI.ConclusionsThe improved quality was likely the result of diverse process measures, many not yet recognized in the literature, which came together effectively in specific hospitals.

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