11 Mar 2016
The Health Quality & Safety Commission is recommending data on surgical performance and other health care outcomes are publicly reported at a provider, department or team level.
In the position paper on the transparency of information related to health care interventions released today, the Commission says data should be made public in order to improve accountability and public trust in our country’s clinical teams.
The Commission reviewed publications and international evidence on the topic, and consulted with the Ministry of Health, district health boards (DHBs), professional organisations and colleges, and consumers.
“Our review of the evidence suggests public reporting of individual surgeons’ data may have unintended consequences, such as misleading the public,” says Commission Chair Professor Alan Merry. “Hence our recommendation that reporting of data is at provider, department and team level, not individual level.”
He says experienced surgeons who operate on very sick patients may, for example, have higher mortality and complication rates than less experienced surgeons with less difficult cases. Individual surgeons also do not perform enough procedures to allow for statistically useful judgements to be made about their performance.
“We also know from New Zealand and overseas that individual surgeon performance data can change based on the surgical team they are working with. The same surgeon can perform the same operation with a different team with varied outcomes.
“Hospital care is complex and patients are looked after by many members of a team, not just individual surgeons. Their outcomes are dependent on good teamwork and good communication within teams.”
He says the Commission is aiming for transparency of surgical data to inform and reassure the public, as well improve the services they receive.
The Commission recommends a risk-adjustment model is used to account for the many factors which can impact on health care. Risk adjustment allows patients at different ages, levels of health and risks for surgery to be compared.
“For example, risk adjustment allows the results of a 90-year-old with coronary heart disease who is having a hip replacement to be better compared with an otherwise healthy 50-year-old having the same operation,” says Prof Merry.
The Commission and the Ministry of Health will now work with key stakeholders including DHBs to explore the development of appropriate models for data collection, analysis (including risk adjustment) and publication.
The Commission recommends: