Shaping the future of surgery: the role of private regulation in determining quality standards.
OBJECTIVE
To educate surgeons about the growth of the private regulatory movement and its potential implications for the practice of surgery.


METHODS
An in-depth analysis and literature review of one of the largest private regulatory groups, the Leapfrog Group, provides a model for understanding the impact of these groups on the practice of surgery. A detailed discussion of the history, mission, structure, and quality initiatives of Leapfrog is included.


RESULTS
Private regulatory groups are using quality standards as a method for controlling the rising cost of health care. Traditionally, little financial support, manpower, or incentives have existed for individual surgeons and hospitals to report and maintain their own outcomes data. However, as surgical outcomes have increasingly become the target of quality improvement initiatives, the need to measure performance is gaining importance. Surgical quality has been both a direct target of private regulation, as illustrated by the evidence-based hospital referral guidelines of Leapfrog, and an indirect target with initiatives like computerized physician order entry and ICU staffing guidelines.


CONCLUSIONS
Private regulation is rapidly reshaping the way we practice and teach surgery. It is almost a certainty that their power, popularity, financial support, and missions will all continue to expand. As surgeons, we must decide soon if we wish to be an active participant in shaping the movement or, rather, if we are going to let it shape us by remaining largely uninvolved.
Department of Surgery, University of Wisconsin-Madison, USA.
Rachael A
RA
Callcut
Tara M
TM
Breslin
D013502:General Surgery / Q000193:education*; D006265:Health Care Coalitions; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D019984:Quality Indicators, Health Care; D013514:Surgical Procedures, Operative / Q000193:education; D014481:United States