John Hwang’s impact at Fraser Health (FH) extends much further than the operating rooms at Royal Columbian Hospital (RCH) in New Westminster. The general surgeon is a long-time champion of quality improvement (QI), and he’s become an inspiration for both leaders and frontline staff to make QI a part of their everyday work.
“John is an exemplary leader who goes above and beyond in his strides to engage employees and physicians in quality improvement initiatives for enhancing patient care,” says Darlene Mackinnon, a former Executive Director at RCH.
For his part, John sees the work of quality improvement as a crucial piece toward bettering the health care system overall. It’s why he’s so passionate about it.
“I think this is really important work,” says John. “Most of us assume that high quality care is automatically built into our health processes, but this isn’t necessarily true. Most of the time, when patients fall through the cracks, its entirely predictable and a symptom of a system that doesn’t do what its supposed to do. And the only way we can fix the health system (through health systems redesign) is by engaging and training those that live within the system… the frontline workers.”
John’s fingerprints on QI at Fraser Health can be found across the health authority, from wound care to surgical care and recovery, to physician QI instruction and mentorship.
In 2018, he implemented an innovative multidisciplinary wound care model at FH’s Complex Wound Centre (CWC), leading to a 60% reduction in chronic wound healing time for high-risk patients, and helping avoid a cost of $47,500 per patient. John subsequently spread this transformative care model to 13 FH home health wound care clinics, established a new regional wound care advisory committee, and introduced monthly regional multidisciplinary complex wound rounds.
John shared his learnings at the 2019 Institute for Healthcare Improvement (IHI) Forum, the 2022 Wounds Canada Conference, and at the University of Western Ontario’s Master of Clinical Science program, as well as published on his experience in BMJ Open Quality.
John has also assumed leadership roles to enhance quality in surgery. He served as the National Surgical Quality Improvement Program (NSQIP) Surgeon Champion for RCH from 2011 to 2022. He was responsible for the hospital’s achievement of the coveted “NSQIP Meritorious Hospital” designation in 2021, a distinction awarded to only 90 hospitals in North America. John was also the regional lead for the Enhanced Recovery after Surgery (ERAS) initiative, the Comprehensive Unit-Based Safety Program (CUSP), and the Surgical Site Infection (SSI) Reduction initiative. He was a pivotal contributor to the Surgical Quality Action Network (SQAN) and the Surgical Pre-operative Optimization Collaborative (SPOC).
John’s commitment to QI extends beyond the surgical realm. He is the visionary behind the Annual RCH QI Day, an event launched in 2015 to bring together patients, frontline staff, and health authority leaders to showcase site QI projects, foster knowledge sharing, and collaboratively build a culture of continuous improvement. The most recent gathering, held in May 2023, attracted over 150 attendees.
Dialogues stemming from these events have led to the creation of robust, frontline-driven QI programs, such as the RCH QI League. In September 2022, in partnership with the RCH Foundation, John was named the QI Lead for the Advancing Innovation in Medicine (AIM) Institute, which strives to push the boundaries of QI and innovation at RCH. Recognizing his unwavering dedication to frontline engagement and QI, John received the FH Above and Beyond Innovator Award in 2016 and was honored as an RCH Foundation Champion of Philanthropy in 2022.
John has also been a long-time faculty member of FH’s Physician Quality Improvement (PQI) program and served as its Physician Advisor from 2018 to 2021. Under his guidance, the program expanded its educational offerings, recruited new faculty members, and successfully transitioned its curriculum to a virtual format during the COVID-19 pandemic.
John has taught QI to hundreds of frontline staff and physicians, has mentored numerous providers in their QI endeavours, and coached a myriad of improvement projects. But, says Barbara Drake, past Interim Director of Clinical Operations at RCH, he never forgets why QI is so important in the first place.
“What I really admire about John,” says Barbara, “is that he never loses sight of the fact that there is always a patient at the centre of this work, and he really likes to see that we move forward in improving the patient experience and the patient outcomes.”
