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Hospitals to publish surgeons’ performance data

Hospitals will be required to publish data on the survival rates and quality of care provided by individual surgeons from next summer.

The edict from the NHS Commissioning Board (NHSCB) is one of a raft of measures which focus on outcomes and information set out in planning guidance for 2013/4 for clinical commissioning groups, which start operating in April next year.

The guidance, which plays a similar role to the NHS Operating Framework in the past, sets out the incentives and levers that will be used to improve services.

From 2014/15 NHS trusts will be have a contractual obligation to publish data from ten specialties including cardiac, vascular and orthopaedic surgery to allow comparison across hospitals.

Cardiothoracic surgeons have been publishing outcomes data for individual consultants since 2005 and it was intended that other specialties would follow their lead. But the data has in recent years been left to drift due to a row over funding and the closure of the Healthcare Commission in 2009 which had been collaborating on the project.

The Society for Cardiothoracic Surgeons recently announced that it would start publishing the data again online in the New Year.

The NHSCB’s announcement has been greeted cautiously by doctors’ leaders. Dr Mark Porter, chair of BMA council, said it was important that data published about consultants’ performance was meaningful. “Basic mortality figures alone could mislead patients because they fail to take into account other factors that might have contributed to the death of a patient,” he said.

Professor Norman Williams, president of the Royal College of Surgeons (RCS), said they supported the NHSCB’s pledge to greater transparency but insisted that RCS experts should be involved in designing and delivering the relevant outcome measures.

“Designing ways to measure the outcomes from across surgery that would give credible and meaningful data is extremely complicated and no one-size-fits-all,” he explained. “It is vital that any analysis of surgeons who take on the higher risk patients (such as those with complex health needs like diabetes and respiratory problems) is fair and reflects the complexity of these conditions so as not deter surgeons from treating difficult cases for fear of being penalised.”

Dr Pietro Micheli, associate professor of organisational performance at Warwick Business School, who has worked as an advisor for the UK Department of Health and several NHS trusts, warned that publishing league tables could lead to a breakdown in trust among surgeons and provide a false sense of accountability to the public.

“If the main aim is to generate competition and select out low performers – in this case ‘bad’ surgeons – then league tables will inevitably disincentivise collaboration. Instead league tables will emphasise the role of surgeons as individuals rather than as part of a team. Surgeons could start working against each other rather than with each other and trust between them could be harmed.”

He also suggested that the data could be open to misinterpretation by the public because they often provided a simplistic and misleading representation of reality.

But NHSCB chief executive Sir David Nicholson said providing the data was aimed at allowing surgeons to compare performance, which in turn would in turn put pressure on them to improve.

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One Response to “Hospitals to publish surgeons’ performance data”

  1. Malcolm Morrison says:

    Beware of ‘bare’ ststistics – they are like a Bikini bathing costume: they may reveal a lot, but hide the essentials!

    I’m sure The Press would have a field day from the fact that the best surgeons have the highest mortlity figures! This is because they only ever operate on the most difficult cases; often those that have had complications from previous surgery.

    Mortality rates may be due to several things – some outside the control of the surgeon. If there is inadeqaute ‘suuport’ from junior staff, ward staff, physio (or the patient is not supported when they arrive back ‘in the community) the ‘results’ will suffer. But most surgery, today, is performed with the intention of improving the ‘quality of life’ (which is poorly ‘measured’ by QALYs – which have a ‘subjective element built into them); there are several different ‘measures’ of this – used in differenr ways for different conditions. Thus crude, simplified ‘soundbite’ statistics (which is what The press will publish) could be very misleading!

    Sir David’s remarks (final Para.) show how little he understands about what motivates surgeons! I know of no surgeon who sets out to be a ‘bad’ surgeon; most strive for perfection – even though they know they can’t achieve it. They ‘improve’ more by co-operation and discussion (now called CPD!) rather than by comaprison.

    Retired Orthopod

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