Re: Chance of identifying poor surgeons from mortality data is low, say analysts
Dear Editor,
Nigel Hawkes states that publishing mortality rates for individual surgeons will fail to identify poor performers, particularly in colorectal cancer surgery due to variable case numbers. The reflection of a standalone outcome measure on an individual surgeon’s quality of care is debatable. The outcome of a patient does not depend solely on the actions of the operating surgeon. The involvement of a multidisciplinary team of therapists, nurses and various specialist doctors on patient management must not be overlooked. Evidence suggests that teamwork is linked with patient mortality (1).
Using the current system of reporting an accomplished surgeon’s figures may suffer from poor post-operative care by the multidisciplinary team. In contrast better care by a well-functioning team may compensate for a poorly performing surgeon. In recent years efforts have concentrated on flattening the steep hierarchy in healthcare and adoption of a blame free culture (2,3). The decision to identify individual surgeons and publish their outcomes seems to be a step backwards from this.
Professor Norman Williams, president of the Royal College of Surgeons of England also cautioned that the complexities involved in publishing this data must be “understood and interpreted correctly”. By failing to acknowledge the impact of multi-disciplinary team working on patient outcome the reported figures may be inaccurate and misleading. Consideration should be given to the advantages of unit reporting over individual reporting.
The impact of multiple variables on outcome must be considered before surgeon outcome reporting is universally adopted. Making individual outcomes available to improve patient choice is commendable but the current method requires further optimisation to ensure that any choice made by patients is fully informed based on complete information.
1. Mazzocco K, Petitti DB, Fong KT, Bonacum D, Brookey J, Graham S, et al. Surgical team behaviors and patient outcomes. Am J Surg 2009;197(5):678-85.
2. Vats A, Vincent CA, Nagpal K, Davies RW, Darzi A, Moorthy K. Practical challenges of introducing WHO surgical checklist: UK pilot experience. Bmj 2010;340:b5433.
3. Vincent C, Moorthy K, Sarker SK, Chang A, Darzi AW. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg 2004;239(4):475-82.
Competing interests:
No competing interests
23 July 2013
Maximilian Johnston
Clinical Research Fellow
Pritam Singh, Ara Darzi
Centre for Patient Safety and Service Quality, Imperial College London
10th Floor, QEQM, South Wharf Road, London, W2 1NY
Rapid Response:
Re: Chance of identifying poor surgeons from mortality data is low, say analysts
Dear Editor,
Nigel Hawkes states that publishing mortality rates for individual surgeons will fail to identify poor performers, particularly in colorectal cancer surgery due to variable case numbers. The reflection of a standalone outcome measure on an individual surgeon’s quality of care is debatable. The outcome of a patient does not depend solely on the actions of the operating surgeon. The involvement of a multidisciplinary team of therapists, nurses and various specialist doctors on patient management must not be overlooked. Evidence suggests that teamwork is linked with patient mortality (1).
Using the current system of reporting an accomplished surgeon’s figures may suffer from poor post-operative care by the multidisciplinary team. In contrast better care by a well-functioning team may compensate for a poorly performing surgeon. In recent years efforts have concentrated on flattening the steep hierarchy in healthcare and adoption of a blame free culture (2,3). The decision to identify individual surgeons and publish their outcomes seems to be a step backwards from this.
Professor Norman Williams, president of the Royal College of Surgeons of England also cautioned that the complexities involved in publishing this data must be “understood and interpreted correctly”. By failing to acknowledge the impact of multi-disciplinary team working on patient outcome the reported figures may be inaccurate and misleading. Consideration should be given to the advantages of unit reporting over individual reporting.
The impact of multiple variables on outcome must be considered before surgeon outcome reporting is universally adopted. Making individual outcomes available to improve patient choice is commendable but the current method requires further optimisation to ensure that any choice made by patients is fully informed based on complete information.
1. Mazzocco K, Petitti DB, Fong KT, Bonacum D, Brookey J, Graham S, et al. Surgical team behaviors and patient outcomes. Am J Surg 2009;197(5):678-85.
2. Vats A, Vincent CA, Nagpal K, Davies RW, Darzi A, Moorthy K. Practical challenges of introducing WHO surgical checklist: UK pilot experience. Bmj 2010;340:b5433.
3. Vincent C, Moorthy K, Sarker SK, Chang A, Darzi AW. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg 2004;239(4):475-82.
Competing interests: No competing interests