Recent events, particularly the Inquiry into Children’s Heart Surgery at Bristol Royal Infirmary, have emphasised the importance of recognising deficiencies and acting on these findings. The Inqiry hearings also changed public and professional opinion about the need for much greater public accountability than had been customary.
One of the key recommendations to emerge was the need for systematic internal and external monitoring of the clinical performance of health care professionals and hospitals, with the aim of identifying and sharing examples of good practice and flagging up poor performance.
Clearly, when released into the public domain, data on units and individuals will provide an invaluable source of information to patients, surgeons, regulators and health care planners. But, crucially, their credibility hinges on the reliability and quality of the primary information – and the context in which they are delivered. In the case of individual performance data, most cardiothoracic surgeons remain convinced that risk adjustment is essential to take account of case mix.
This report, based on a study carried out jointly with RAND and the Society for Cardiothoracic Surgery in Great Britain and Ireland, is a contribution to the discussion on the need for systematic internal and external monitoring of the clinical performance of health care professionals and hospitals. It demonstrates the feasibility of producing and publishing risk-adjusted data on the outcome of cardiac artery bypass graft surgery (CABG), and should be essential reading for anyone concerned with how clinical outcome data should be produced and disseminated in the public domain.
White C (2003) Improving the credibility of information on health care outcomes: the cardiac surgery demonstration project. Research report. Nuffield Trust.