Publishing consultant outcomes: A work in progress
21 Nov 2014
Miss Clare Marx, President of the Royal College of Surgeons
The individual outcomes of operations carried out by 5,000 surgeons in England were published this week. An enormous undertaking, involving thousands of hours checking the data, validating the figures, studying the reasons behind variation, talking to the surgeons involved, and informing medical directors where results were out of line with that expected, constitutes possibly one of the most significant moves in openness and honesty that surgery has ever undertaken.
Ask a surgeon in France, Germany or the US if they have published their results, for patients and the public to see. The answer will be only if they are good!
That is one of the reasons why it is so painful to see newspaper headlines that proclaim ‘Death List Docs’, or the Telegraph’s lightly longer version “Only three surgeons are rated poor, says data criticised as ‘laughable’". It’s painful as the stories fail to show the reality of what is actually happening on the ground in every single hospital involved in these audits. We don’t have anything to hide. As a profession, we are robustly scrutinising our surgery and understanding our results as never before.
The RCS has supported the publication of individual surgeons results as a way of improving the quality and safety for patients undergoing surgery. We are clear that the national clinical audits data are simply part of the wealth of information we have that measures quality of the work done by the teams and hospitals caring for the patients. It is part of the bigger jigsaw that enables surgeons and medical directors to know that we are performing to a high standard. HES data, patient feedback, colleague feedback and local audits are all brought together as part of the overall assessment of surgeon performance at appraisal that can then lead to revalidation recommendations.
Surgeons need time to analyse and evaluate their own data. That has been a major challenge for individuals and for the audit providers involved, immensely time consuming, against a background of mounting service pressures. There is no doubt that we need more sophisticated data which includes information about teams to give patients a far better understanding of the potential outcome from an operation.
The NHS website NHS Choices has had difficulties in presenting the data accurately, and they must learn from the surgical specialty associations about how to explain risk adjustment. The associations have gone to great lengths to present the facts in a way that is meaningful to patients and their families alike. This is not window-dressing, but a genuine attempt to communicate measurements that can be difficult to interpret. The Association of Coloproctology, for example, has a very clear explanation of the methodology used in producing outcomes, from which I think NHS choices could learn: http://www.acpgbi.org.uk/surgeon-outcomes/
We all have a duty to our patients to ensure they know why data collection matters, what it can and cannot tell us but importantly how these audits can help us to improve care. What really matters in our quest for improvement is that we use these outcomes to understand our own work and have honest and informed conversations with patients about the nature of surgery and their chances of successful outcome.
However imperfect, the current measurements are better than having no measurement. As a profession it’s our job to keep building on this work to improve it gradually, weathering the headlines and making the case for greater public awareness and understanding of the information published.
Follow Miss Clare Marx, President, Royal College of Surgeons on twitter @ClareMarx