Performance monitoring should take costs to heart

doi:10.1136/bmj.329.7470.856

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Sheila M Bird, senior statistician (sheila.bird@mrc-bsu.cam.ac.uk)

MRC Biostatistics Unit, Cambridge CB2 2SR

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 …