Even before the landmark Canadian Adverse Events study was published in 2004, Dr. Kelly Mayson was already actively reviewing critical incidents in Vancouver General Hospital’s surgical department.
Back then, few understood this was an early example of a quality improvement (QI) initiative, likely including Dr. Mayson herself. Some 20 years later, the anesthesiologist and clinical professor at Vancouver General Hospital (VGH) and UBC Hospital, has developed into a patient safety and quality leader in the province, driving innovation and excellence through health systems transformation at Vancouver Coastal Health, Providence Health Care, and beyond.
“Her enthusiasm for improving care for surgical patients in BC has continued on for many years in the multiple projects she has tackled and led,” says Dr. Trina Montemurro, an anesthesiologist at St. Paul’s Hospital and a former resident under Dr. Mayson’s preceptorship. “Her warm and engaging nature has inspired others to continue with new and important projects. Additionally, Kelly has continued to inspire me to take on new QI projects.”
While she has been involved in many QI initiatives over the years, there are two that feed Dr. Mayson’s passion for improving patient outcomes by focusing on care before and after surgery – the Enhanced Recovery After Surgery (ERAS) initiative, and the provincial Surgical Patient Optimization Collaborative (SPOC).
Under Dr. Mayson’s leadership, VGH became an early adopter in BC for ERAS, which manages care before, during and after surgery to help patients heal and get back to everyday functions as soon as possible. For some, the guidelines and processes of ERAS may be counterintuitive. For example, instead of bed rest, patients are encouraged to get up and walk sooner. Instead of fasting, they are allowed to drink up to two hours before surgery, including carbohydrate-loaded liquids. Dr. Mayson saw potential in the changes, and used data including the standardized registry of the National Surgical Quality Improvement Program (NSQIP) to show successes.
“She’s very practical and approachable,” says ERAS coordinator Julie Nakahara. “Dr. Mayson is always encouraging the team to think about what can we do now, and how can we sustain this for the future. By working with the team to get ideas and including team members from the very beginning, people are engaged with and want to do the work.”
Dr. Mayson was also inspired to pursue surgical optimization of patients after seeing some experience long hospital stays due to poor pain control, persistent nausea and vomiting, poor glycemic control and anemia. To decrease these complications, she advocated for a multidisciplinary team including surgeons, anesthesiologists, family physicians, medical internists, nurses, social workers, dietitians and physiotherapists to create a process that would check patients for pre-existing health conditions, malnutrition, pre-exisiting pain and harmful behaviours such as smoking, drinking, and drug use well before surgery. The waiting time to surgery is then used to prepare the patient’s mental and physical health through exercise, lifestyle changes, nutrition, review of medications and the elimination of the harmful behaviours.
Dr. Mayson took this one step further by leading VGH’s participation in SPOC, to create a bigger community of care providers who could share knowledge and tools. She is now a co-lead of the provincial collaborative.
To ensure there is physician involvement in QI, Dr. Mayson has also been involved with the Physician Quality Improvement (PQI) program since 2016. In its early days, PQI was mostly a training program. Dr. Mayson saw its potential to not only train physicians in QI, but to use it to build a relationship with VCH leadership. Upon becoming chair of the PQI steering committee in May 2019, she met with leadership to better understand the health authority’s priorities, and then worked to integrate physicians’ QI projects within them.
This collaborative approach has been echoed across her work, including during the pandemic. Surgeries of all kinds had been postponed, creating longer waitlists and uncertainty about what kind of post-surgical complications patients who had had COVID-19 might experience. Dr. Mayson looked for an evidence-informed approach to support surgical care during the pandemic, which led to VGH joining the international collaborative COVIDSurg, to which she contributed local data.
She also knew patients’ need for accurate information in a constantly evolving landscape, so she brought together colleagues and a patient advisor to create patient education handouts that would better communicate with people and their families, creating a better patient experience, and helping standardize information so that front-line staff could more easily communicate with those they were caring for.
“Dr. Mayson is an inclusive leader. She has a genuine interest to ensure all perspectives are heard, seeking inputs from the various clinical team members in quality improvement projects, and consensus building,” says Vivian Chan, Director of Medical Quality and PQI health authority sponsor. “She has been an early champion of system and quality improvement and has put in many hours of her time outside of her clinical work to contribute to leading QI as well as QI knowledge translation. She is a reliable and trusted physician leader.”