BMJ  2004;329:856 (9 October), doi:10.1136/bmj.329.7470.856

Letter

Performance monitoring should take costs to heart

The first 150 words of the full text of this article appear below.

EDITOR—The three papers on the performance of cardiac surgeons in the issue of 21 August show that expertise combined with statistical thinking can lead to rational performance monitoring without bullying overtones, disputed targets, or misconceived "naming and shaming."^1-5

Publicly naming individual surgeons as "not meeting" even the 99.99% standard proposed by Keogh et al remains problematic if the underlying problem is commonly discovered to be specific to a process or organisation rather than a surgeon.³ Until an empirical database exists that clearly persuades cardiac surgeons and the public that resolutions from "taking a closer look" under the proposed new monitoring scheme are more likely to be surgeon specific than institutional, politicians and others should not publicly name the surgeons whose results trigger taking a closer look. Instead, report only that a closer look is being taken, the results being fairly and frankly reported at a specified date. The . . . [Full text of this article]

MRC Biostatistics Unit, Cambridge CB2 2SR sheila.bird@mrc-bsu.cam.ac.uk

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