The death of death rates?

The history of medicine can be characterised as a long struggle against ignorance and ineptitude.1 In revealing the complexity of human disease, medical science has chipped away at the former while increasing the risk of the latter. A profession that was once responsible for balancing four humours is now obliged to juggle over 14 000 discrete conditions. Fumbles are inevitable. But to what extent are they avoidable?

The National Health Service is still dealing with the fallout from the Francis inquiry into failings at Mid-Staffordshire NHS Foundation Trust.2 One of its first responses was to dispatch Bruce Keogh, the national medical director, to investigate other places of concern—hospitals with persistently high mortality rates.3 But was this the best way to identify rogues?

In a linked article (doi:10.1136/bmj.h3239), Hogan and colleagues measured the association between death rates reported by hospitals and the number of deaths they should have avoided.4 This is a vital piece of information. A strong link would mean that comparative mortality data could serve as a system-wide smoke alarm, providing administrators with an efficient means of monitoring quality of …