When I was in medical school and during my orthopaedic residency, I never thought I would have the privilege, the opportunity, and the challenge of leading this specialty, which I think has the most potential to maintain and improve the quality-of-life for patients of all ages.For our patients, “quality of life” is simple. It means they can continue to do what they’ve always done—whether that is living independently, playing golf or tennis, participating in sports and exercise, or walking along a beach with their families.


Published 4/1/2010
John J. Callaghan, MD

Turning expectations of quality into reality

But for those of us who practice medicine—specifically those of us who practice orthopaedics—quality has multiple meanings, particularly in this era of healthcare reform. Quality may be defined as “the degree of excellence that a thing or person possesses.” But who defines “excellence”? Who determines the “degree of excellence” that equates to “quality”? And what are the implications of these decisions to us as orthopaedic surgeons and to our patients?

A vision of quality in education
Both the Academy’s vision statement—“to be the authoritative source of knowledge and leadership in musculoskeletal health”—and its mission—“to serve the profession, champion the interests of patients, and advance the highest quality musculoskeletal health”—support the goal of quality in medicine.

Providing quality musculoskeletal care begins with education. The Academy not only educates orthopaedists, it reaches out to other musculoskeletal providers, to those involved in making decisions about resource expenditures in musculoskeletal care, and to patients.

Take, for example, the Annual Meeting. Last month, despite the economy, more than 15,000 orthopaedic surgeons and other healthcare professionals took time away from their practices to better educate themselves so they could provide quality care for their patients.

But simply attending is not enough. Exposure to new ideas and evidence-based studies challenges what we think we know. Quality results when we confront that challenge, think about what we’ve learned, and apply it to our practices and our patients.

Similarly, board certification and maintenance of certification (MOC) are ways to demonstrate our commitment to quality of care. Our participation in this voluntary process of self-regulation and achievement of objectives to ensure continued, contemporary competence, should comfort our patients. Our Academy supports these efforts through self-assessment examination modules, continuing medical education (CME) offerings, and specialty self-assessment tests.

The ongoing relationships and unity efforts between the AAOS and our specialty society partners enhance these educational efforts. Such partnerships are integral to many quality initiatives, including surgeon education, practice management, patient education, and research.

Research to support quality care
As many of you know, research is one of my lifelong passions. Now that the Obama administration has issued a call for comparative effectiveness initiatives and injected $1.1 billion of funding into National Institutes of Health, research to support quality care has come front and center.

The AAOS Council on Research, Quality Assessment and Technology provides an infrastructure for the development of clinical practice guidelines and an overview of new technologies. It also gives us the potential to develop and provide feedback, and to contribute to the educational component of practice improvement modules under the MOC process.

In many other specialties, surgeons embrace guidelines that enable them to function more efficiently and to provide better, cost-effective care for their patients. I encourage orthopaedic surgeons to review the AAOS guidelines to see which might help you and your patients. I also encourage both basic and clinical researchers to look at the areas where expert panels found inconclusive evidence for treatment. In these areas, high-quality basic and clinical investigations can provide the scientific information to determine the effectiveness of our interventions for our patients.

The simplicity and effectiveness of guidelines (in the form of checklists) is obvious in a new book by Atul Gawande, MD. The Checklist Manifesto shows how using checklists in all aspects of our practices—especially in the operating room—can reduce medical errors and postsurgical infections while increasing patient satisfaction.

Another effort through which research supports quality care is the American Joint Replacement Registry, soon to be a reality in this country. It will dwarf all other registries in the world, with the potential for 750,000 entries in the first year. Other national registries have been shown to markedly improve the quality of care by behavior modification based on an analysis of individual results versus peer results, whether it be the surgeon, the hospital, or the implant manufacturer.

Although it has taken us more than 9 years, I am convinced that this registry will come to fruition, demonstrating the commitment of orthopaedic surgeons to the quality movement. It will be one way the orthopaedic profession optimizes quality and value in the performance of surgical procedures needed by millions of Americans.

Communicating quality
In the past, we could simply tell the various stakeholders and our patients that the AAOS is the greatest association in medicine and that orthopaedists provide the best care for patients afflicted with musculoskeletal conditions. But, in 2010, we must show them!

This means continuing to demonstrate the Academy’s commitment to quality. For example, through the efforts of the Board of Councilors, Board of Specialty Societies, and Committee on Professionalism, six Standards of Professionalism (SOPs) have been developed. These SOPs, covering areas such as appropriate expert testimony, relationships with industry, and research responsibilities, reinforce the obligations that we have and provide an avenue for reporting violations.

As a member of the American Orthopaedic Association Conflict of Interest Project team, I reviewed similar programs from other professional organizations. Based on that review, I can assure you that our program is exemplary and well communicated on our Web site and in our publications.

Our new Orthopaedic Disclosure program is also exemplary in medicine. As a public database, it reflects the quality of professionalism required to stay in “good standing” with the organization and reinforces how seriously we take self-regulation.

We communicate these messages on multiple fronts and through multiple avenues both to the fellowship and the public. The quality of these communications is high, reflecting the professionalism of our volunteers and staff working together. Whether you read about these initiatives in Headline News Now, AAOS Now, or Advocacy Now, whether your patients see our public service announcements, read our patient education brochures and Web site, or follow the AAOS on Facebook and Twitter, the message is the same—quality in musculoskeletal care from orthopaedic surgeons.

Advocating for quality
The quality agenda in medicine is directly tied to healthcare reform. In this area, too, I intend to keep moving forward on the path set by my predecessors—advocating for a healthcare reform plan that lives up to our principles, keeping you informed and encouraging your participation in the process, and helping to shape the quality movement in a way that will enhance the true value of us as orthopaedic surgeons.

This month, the AAOS board will meet to determine the best ways to use the Academy’s resources to ensure that we are players in the quality movement. We hope to engineer some of the issues important to our profession rather than simply ride the quality train.

It is not enough just to know the “alphabet soup” of quality initiatives. It is not enough to give lip service to efforts to improve quality of care. We must all consider how we can enhance the quality of our individual orthopaedic practices, whether that be engaging in MOC, implementing electronic medical records, instituting a hand washing program, following clinical practice guidelines, or contacting your Congressional representative to educate him or her on the impact of proposed healthcare reform provisions.

When much has been given, much is expected. I appreciate the opportunity you have given me to lead this organization. I intend to meet your expectations. Let us all commit to improving quality in our practices—every day, in every surgery, for every patient.