For healthcare professionals only

Education And Debate

The legacy of Bristol: public disclosure of individual surgeons' results

BMJ 2004; 329 doi: (Published 19 August 2004) Cite this as: BMJ 2004;329:450
  1. Bruce Keogh, president elect (,
  2. David Spiegelhalter, statistical adviser1,
  3. Alan Bailey, data coordinator, UK cardiac surgical register2,
  4. James Roxburgh, secretary1,
  5. Patrick Magee, president1,
  6. Colin Hilton, immediate past president1
  1. 1 Society of Cardiothoracic Surgeons of Great Britain and Ireland, Royal College of Surgeons of England, London WC2A 3PE
  2. 2 The Limes, Charfield, Wotton-under-Edge GL12 8SR
  1. Correspondence to: B Keogh
  • Accepted 24 June 2004

Measurement of outcomes from medical or surgical interventions is part of good practice, but publication of individual doctors' results remains controversial. The authors discuss this issue in the context of cardiothoracic surgery


After the General Medical Council hearings and the subsequent Bristol Royal Infirmary Inquiry into paediatric cardiac deaths, cardiac surgeons expected a stinging attack on British cardiac surgical practice. What emerged instead, in 2001, was a comprehensive report highlighting many of the difficulties facing frontline clinicians and managers in the NHS.1

The story of the paediatric cardiac surgical service in Bristol is not an account of bad people. Nor is it an account of people who did not care, nor of people who wilfully harmed patients. It is an account of people who cared greatly about human suffering, and were dedicated and well-motivated. Sadly, some lacked insight and their behaviour was flawed. Many failed to communicate with each other, and to work together effectively for the interests of their patients. There was a lack of leadership, and of teamwork. It is an account of healthcare professionals who were victims of a combination of circumstances which owed as much to general failings in the NHS at the time than to any individual failing.1

The report included 198 recommendations, of which two stated that patients must be able to obtain information on the relative performance of the trust and of consultant units within the trust. This led to an increasing belief that the interests of the public and patients would be served by publication of individuals' surgical performance in the form of postoperative mortality. A precedent for this existed in the United States, where in 1990, the New York Department of Health published mortality statistics for coronary surgery for all hospitals in the state, and has published comparable data …

View Full Text

Log in

Log in through your institution


* For online subscription