Intended for healthcare professionals

Rapid response to:

Information In Practice

Performance league tables: the NHS deserves better

BMJ 2002; 324 doi: (Published 12 January 2002) Cite this as: BMJ 2002;324:95

Rapid Response:

The right tool for the job

Yet again a right on the button article from the Public Health team
in Birmingham. What I would add to the statistical process control (SPC) /
league table debate is this.

The league table is nothing more than an ordered list of cumulative
data from different sources. It gives no indication of current trends
within the data. Following publication of a league table, the hospital is
left to explain and perhaps undertake an investigation to justify its
position within a table – a position that does not necessarily require
justification. On the other hand hospitals producing data as SPCs have
several advantages. Not only will the SPCs provide a measure of cumulative
data (the centre line or mean) they will also give information on the
current trends. The data can be used to feedback to those involved in the
processes that generate the data to drive quality improvement. The SPC is
only a means to identify when there is a problem - special causes from
common causes. It can not identify what the problem is. Other total
quality management tools including Fishbone and Pareto charts can identify
all the possible causes and rank the most common causes.
In summary it should be remembered that league tables are produced with
the hope of improving performance, SPCs are designed so to do and have a
proven track record.

Competing interests: No competing interests

29 January 2002
Evonne T Curran
Area Infection Control Nurse
NHS Greater Glasgow