VA Surgical Outcomes Among the Best in the U.S.

Dr. Mark Lockett, vice chair of Veterans Affairs

A recent analysis performed by the Veterans Affairs Office of the Inspector General (OIG) to evaluate operating room efficiency revealed MUSC’s affiliated VA, the Ralph H.Johnson Veterans Affairs Medical Center (RHJVAMC) ranked 2nd out of 135 facilities. The audit team analyzed operating room efficiency data from 2014-2018 byscoring outcomes for OR utilization, first case on timestart percentage, turnover time between cases, and case cancellations. The OIG performed the analysis to determine factors contributing to efficiency. More efficient operating rooms utilize resources more effectively and provide better access to care for patients.

Much has changed in the RHJVAMC surgical program since Mark Lockett, M.D. took over as the Chief of Surgery and joined MUSC’s surgery department as the Vice Chair of Veterans Affairs in 2011. When he arrived at RHJVAMC, the surgery program was considered a poor-quality outlier within the VA system. Working with facility leadership, surgeons,anesthesia, nursing and others he helped chart a course that resulted in significant improvements in outcomes.

As quality issues improved, VA Surgical Services began to focus on expanding care expertise and access. As Charleston and the surrounding areas grew, so did the number of veterans seeking care at RHJVAMC. It has been one of the fastest growing VA Hospitals in the country. “When I started in 2011, we had 44 full-time-equivalent faculty,” said Lockett. “We now have 98 clinicians, 23 advanced practice providers, 24 health care technicians, and support educational efforts for 22 MUSC residents. 40 of our 61 surgeons work at MUSC as well as the VA.The relationship with MUSC helped us build a robotic surgery program, create a bariatric surgery program, bring breast cancer care to the VA, establish a comprehensive gynecology program, start a cochlear implant program, and expand expertise in all 13 of our surgical sections.”

With programmatic growth, more complex care, increased patient volume and staffing, the surgical productivity data improved as well. The RHJVAMC consistently ranks in the top 5 hospitals in VA in productivity per operating room. Despite the challenges of COVID-19, RHJVAMC ORs ranked 2nd in fiscal year 2020. “We’ve added high quality and high complexity care at the VA over the years,” said Lockett.

“While our hospital is not large it provides some of the most complex care in the VA system. We are able to do this in part because of the excellent relationship we have with MUSC Health. Our goal is for patients and providers to not notice a difference in care between being ata complex tertiary referral center like MUSC and the RHJVAMC. The paint on the walls may be different, but the care should be the same.” Lockett credits the hard work and surgical expertise MUSC Health providers offer at the VA as a significant part of why the RHJVAMC has one of the most efficient and productive ORs in the largest healthcare system in the country.

In addition to his leadership at the VA, Dr. Lockett holds a number of other leadership positions. His track record of improving quality at the VA was a significant reason Prabhakar Baliga, M.D., chair of the Department of Surgery, named him the Surgical Lead for the South Carolina Surgical Quality Collaborative. In this role, he helps guide quality improvement efforts at multiple hospitals across South Carolina. He performs a similar role as the Surgery Integrated Clinical Community lead for the VA’s region7, which includes South Carolina, Georgia, and Alabama. His other leadership roles include being a member of the leadership team of the Louisiana Hospital Association’s Surgical Quality Collaborative, Chair of the MUSC Opioid Task Force, and Course Director of the MUSC Postgraduate Course in Surgery.

Whether consulting with a newly diagnosed cancer patient in his busy surgical oncology practice, building a new program at the VA to improve patient outcomes, or training the next generation of surgical leaders, Lockett always keeps the patient in the forefront of his decision making. “A lot of my roles are administrative roles, but I approach all of them from the standpoint of putting patients first,” said Lockett. “Every decision we make needs to be geared toward taking better care of patients.”