BACKGROUND: Surgery quality initiatives improve clinical outcomes in cardiac and general surgery. No mature thoracic surgery (TS) regional effort has been described.

METHODS: An intramural grant funded the Thoracic Surgery Initiative (TSI). Using professional organization, site specific administrative and clinical databases, surgeons performing TS across a large western health system were identified. Participants were recruited through stakeholder surveys, personal contact and meetings. Differences in practices and outcomes were identified. 14 centers performing TS in 5 states formed the TSI with a mission to define, implement and monitor TS quality.

RESULTS: A TS data system based on Society of Thoracic Surgeons General TS Database was implemented. 2015/2016 clinical data revealed significant differences in outcomes. Clinical data allows quality implementation including identification and propagation of internal best practices and monitoring. TS practice standardization was agreed to using predefined TS best practice components that were incorporated into standardized TS care documents. Standardized care document completion by providers was intended to provoke desired TS care. The standardized care documents reside on the system wide electronic health record. Using literature and substantial surgeon experience, standardized TS care pathways for important or common clinical scenarios were developed (pneumonectomy, primary spontaneous pneumothorax, etc). The TSI internet site serves as a harbor for standardization products.

CONCLUSIONS: The TSI is evolving. Surgeon engagement remains high. The TSI enabled surgeons to lead, set the agenda and remain in control of our destiny. Indeed, health care cannot appropriately evolve without such physician vision, engagement and leadership.