Hospital performance scorecards have been welcomed as a sign of Labor’s commitment to transparency and accountability.
The problem with scorecards is that they are so easily fudged. You only need to look at the example of Olympic 2008 host Beijing, which this week has been caught manipulating the smoggy city’s measures for “blue sky days” and pollution.
In theory, mandatory reporting of medical performance indicators and the resultant increased public scrutiny should drive improvements in quality. But what is the evidence to support this?
In this field UK is a bit further down the track, with mandatory reporting of surgical outcomes in place following a public inquiry into paediatric surgery procedures at the Bristol Royal Infirmary. As a result, mortality data for has been made available on public websites such as the Healthcare Commission.
Has this made a difference? A recent retrospective analysis of data from more than 25,000 cardiac surgery patients concluded that the dissemination of mortality data has been followed by reductions in mortality. The authors said there was also no evidence to support the belief that surgeons would be discouraged from accepting high risk patients.
But writing in the same journal, Dr Michael Ward of the Cardiac Society of Australia and New Zealand says this conclusion is “wishful thinking” and contradicts evidence from other mandatory reporting regimes. He says a more likely explanation is that increased public scrutiny puts pressure on surgeons to label patients as having a worse prognosis.
For a league table system to be anything other than a smokescreen it will need a process to ensure objective reporting – and the funding and bureaucracy to achieve that.
Otherwise, “these systems become as trustworthy as most other forms of advertising,” he says.
Another downside of public airing of outcomes is a risk averse approach in surgical training. “Consultants are far less likely to allow trainees to attempt difficult procedures when adverse outcomes will be publicly and wholly attributed to the consultant. The result is rapid deskilling of the workforce,” he says.
What do you think?
Comments
Remember a Health Minister named Richardson who introduced waiting lists as a measure. They have continued on for years with little real value. They have been manipulated and continue to be so. Similarly this idea has some merit but its imprlementation will not be easy. Few hospitals are directly comparable and while I applaud the transparent collection and use of sentinel event data for improving care it might be difficutl to find material that is common to all hospitals that is really useful. Interhospital comparisons as used by the Womens and Childrens hospital group are I think helpful but also open to manipulation. In the end result health professionals might be able to make sense of the results and recognise the pitfalls but what about the poor old customers. The mortality statistics of a hospitsl like Peter McCallum dealing in cancer might well put them right off. Posted by David Formby on Thursday, 13 March 2008
Beware the concept of transparency and accountability. I agree with the comments from Dr Michael Ward above. It seems like the right thing to do - but in practice extremely difficult to achieve in any meaningful or fair way. The article above explains why in the case of heart surgeons. In the case of school reports for example, the "transparency" has meant that teachers in the UK are now afraid to say what they really think in school reports because anyone can access them. This is a serious problem. Australia is now following the UK (as usual) where the Blair-initiated mantra has been "accountability and transparency" for some time now. I don't believe you can trust Government to deliver this information accurately. The wider issue is that the transparency is not matched by the equally important and opposite, personal responsibility. People assume they have rights (and are quick to blame via the "transparency") but don't take responsibility. Posted by chris rook on Thursday, 6 March 2008
