Book contents
- Frontmatter
- Contents
- List of contributors
- Acknowledgements
- Introduction: Accountability, informed consent and clinician performance information
- Part I Accountability
- Part introduction
- 1 Clinician report cards and the limits of evidence-based patient choice
- 2 Report cards for institutions, not individuals
- 3 Safety, accountability, and ‘choice’ after the Bristol Inquiry
- 4 Public reports: putting patients in the picture requires a new relationship between doctors and patients
- 5 Adverse event disclosure: benefits and drawbacks for patients and clinicians
- 6 Report cards and performance monitoring
- Part II Informed consent
- Part III Reporting performance information
- Index
- References
6 - Report cards and performance monitoring
Published online by Cambridge University Press: 08 August 2009
Book contents
- Frontmatter
- Contents
- List of contributors
- Acknowledgements
- Introduction: Accountability, informed consent and clinician performance information
- Part I Accountability
- Part introduction
- 1 Clinician report cards and the limits of evidence-based patient choice
- 2 Report cards for institutions, not individuals
- 3 Safety, accountability, and ‘choice’ after the Bristol Inquiry
- 4 Public reports: putting patients in the picture requires a new relationship between doctors and patients
- 5 Adverse event disclosure: benefits and drawbacks for patients and clinicians
- 6 Report cards and performance monitoring
- Part II Informed consent
- Part III Reporting performance information
- Index
- References
Summary
Introduction
There is little doubt that report cards provide valuable information to enable surgeons to improve outcomes for patients. However, we believe report cards for surgeons are only the first step towards a systematic improvement of all healthcare outcomes for all patients. There is no reason why report cards should be confined to surgeons, and our work with anaesthetists at Geelong Hospital confirms this view. Furthermore, we believe that the crude mortality rates, or even risk-adjusted mortality rates, currently provided to surgeons are the early primitive analyses that will be replaced by more meaningful performance charts as these become more accepted by the healthcare professions. Again, our work in Geelong supports this contention. We believe that local data collection by the healthcare worker is a reliable and trusted means of entering data into appropriate databases for analysis. Our reasons for reaching this conclusion relate to two considerations of the trust that this data requires. Firstly, the individual whose performance is to be assessed or monitored by the data collection must trust the data. Some of the early data collections were not trusted by the clinician participants, and this led to a mistrust of databases by clinicians in practice (Black, 1997, 1999a). However, the conclusions from the work of Professor Nick Black, an epidemiologist at the London School of Hygiene and Tropical Medicine, is that better databases will gain the confidence of clinicians; and collecting data relating to performance in a manner that clinicians believe contains the relevant data on their performance will improve the performance of individuals and organisations (Black and Payne, 2003).
Information
- Type
- Chapter
- Information
- Informed Consent and Clinician AccountabilityThe Ethics of Report Cards on Surgeon Performance, pp. 91 - 106Publisher: Cambridge University PressPrint publication year: 2007
References
, , et al. (2001). Comparison of UK paediatric cardiac surgical performance by analysis of routinely collected data 1984–96: was Bristol an outlier?The Lancet, 358, 181–7.CrossRefGoogle Scholar
and (1973). Principles of Biomedical Ethics. 1st edn., New York: Oxford University Press.Google Scholar
and (2001). Improving the quality of health care: who will lead?Health Affairs, 20, 164–79.CrossRefGoogle ScholarPubMed
and (2000). A comparison of observational studies and randomised controlled trials. New England Journal of Medicine, 342, 1878–86.CrossRefGoogle Scholar
, , , and (2002). Professional monitoring and critical incident reporting using personal digital assistants. Medical Journal of Australia, 177, 496–9.Google ScholarPubMed
and (2004). Challenges in the care of the acutely ill. The Lancet, 363, 970–7.CrossRefGoogle ScholarPubMed
(1997). Developing high quality clinical databases. British Medical Journal, 315, 381–2.CrossRefGoogle ScholarPubMed
(1999a). High-quality clinical databases: breaking down barriers. The Lancet, 353, 1205–6.CrossRefGoogle Scholar
(1999b). What observational studies can offer decision makers. Hormone Research, 51 (Suppl. 1), 44–9.CrossRefGoogle Scholar
and (2003). Directory of clinical databases: improving and promoting their use. Quality and Safety in Health Care, 12, 348–52.CrossRefGoogle Scholar
(2000). Routes to Quality Assurance: Risk adjusted outcomes and personal professional monitoring. International Journal for Quality in Health Care, 12, 367–9.CrossRefGoogle ScholarPubMed
(2005). Personal digital assistants (PDAs) – improving patients' safety. British Medical Journal, 331, 57–8.Google Scholar
Bolsin, S. N. and Day, C. J. (1998). Risk evaluation, quality of practice and audit. In A Short Practice of Anaesthesia, ed. and . London: Chapman Hall, pp. 111–22.Google Scholar
and (2000). Methodology Matters; CUSUM. International Journal for Quality in Health Care, 12, 433–8.CrossRefGoogle Scholar
and (2003). The use of statistical process control methods in monitoring clinical performance. International Journal for Quality in Health Care, 15, 445.Google Scholar
, , , and (2004). Electronic incident reporting and professional monitoring transforms culture. British Medical Journal, 329, 51–2.CrossRefGoogle ScholarPubMed
, and (2005). Using portable digital technology for clinical care and critical incidents: a new model. Australian Health Review, 29, 297–305.CrossRefGoogle ScholarPubMed
, and (2005). Practical virtue ethics: healthcare whistleblowing and portable digital technology. Journal of Medical Ethics, 31, 612–18.CrossRefGoogle ScholarPubMed
, , and (2005). New technology to enable personal monitoring and incident reporting can transform professional culture: the potential to favourably impact the future of health care. Journal of Evaluation in Clinical Practice, 11, 499–506.CrossRefGoogle ScholarPubMed
(2005). A Safer Place for Patients: Learning to Improve Patient Safety. London: National Audit Office.Google Scholar
(1994). Health care reform is on the way: do we want to compete on quality?Annals of Internal Medicine, 120, 84–6.CrossRefGoogle ScholarPubMed
, and (1997). The PACE (population-adjusted clinical epidemiology) strategy: a new approach to multi-centred clinical research. Quartely Journal of Medicine, 90, 147–51.Google ScholarPubMed
(2002). Achieving and sustaining improved quality: lessons from New York State and cardiac surgery. Health Affairs, 21, 40–51.CrossRefGoogle ScholarPubMed
, , , and (1989). Differences among hospitals in Medicare patient mortality. Health Services Research, 24, 1–31.Google ScholarPubMed
, and (2002). Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non-cardiac surgery. British Journal of Anaesthesia, 89, 747–59.CrossRefGoogle ScholarPubMed
and (2004). Informed consent and surgeon's performance. Journal of Medicine and Philosophy, 29, 11–35.CrossRefGoogle Scholar
, and (2000). Randomised, controlled trials, observational studies, and the hierarchy of research design. New England Journal of Medicine, 342, 1887–92.CrossRefGoogle Scholar
and (2003). The use of statistical process control methods in monitoring clinical performance. International Journal for Quality in Health Care, 15, 445.CrossRefGoogle ScholarPubMed
, , , and (1994). Analysis of a cluster of surgical failures: application to a series of neonatal arterial switch operations. Journal of Thoracic and Cardiovascular Surgery, 107, 914–23.Google ScholarPubMed
(1998). Florence Nightingale: basing care on evidence. Royal College of Midwifery Midwives Journal, 1, 192–3.Google Scholar
and (2004). Three Australian whistleblowing sagas: Lessons for internal and external regulation. Medical Journal of Australia, 181, 44–7.Google ScholarPubMed
, , , and (2006). Voluntary incident reporting by anaesthetic trainees in an Australian hospital. International Journal for Quality in Health Care, 18, 452–7.CrossRefGoogle Scholar
(2004). The detrimental ethical shift towards cynicism: can medical educators help prevent it?Medical Education, 38, 232–4.CrossRefGoogle Scholar
, and (2003). Students' attitudes and potential behaviour with regard to whistle blowing as they pass through a modern medical curriculum. Medical Education, 37, 368–75.CrossRefGoogle ScholarPubMed
and (1995). Report cards on surgeons. Assessing New York State's approach. New England Journal of Medicine, 332, 1229–32.CrossRefGoogle ScholarPubMed
and (1994). The hidden curriculum, ethics teaching and the structure of medical education. Academic Medicine, 69, 861–71.CrossRefGoogle ScholarPubMed
(1989). The relation between volume and outcome in health care. New England Journal of Medicine, 340, 1677–9.CrossRefGoogle Scholar
(1996). Report cards: are they passing or failing? One New Yorker thinks they're passing. Clinical Performance and Quality Health Care, 4, 218–19.Google ScholarPubMed
, , , and (1989). Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. Journal of the American Medical Association, 262, 503–10.CrossRefGoogle ScholarPubMed
, , et al. (1992). A longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed. Health Services Research, 27, 517–42.Google ScholarPubMed
, , , and (1994). Improving the outcomes of coronary artery bypass surgery in New York State. Journal of the American Medical Association, 271, 761–6.CrossRefGoogle ScholarPubMed
, , , , and (1997). Assessment of coronary artery bypass graft surgery performance in New York: is there a bias against taking high-risk patients?Medical Care, 35, 49–56.CrossRefGoogle Scholar
, , , , and (1988). Comparison of predictions based on observational data with the results of randomized controlled clinical trials of coronary artery bypass surgery. Journal of the American College of Cardiology, 11, 237–45.CrossRefGoogle ScholarPubMed
, and (1996). Context in medical education: the informal ethics curriculum. Medical Education, 30, 353–64.CrossRefGoogle ScholarPubMed
(1997). The performance of doctors. II: Maintaining good practice, protecting patients from poor performance. British Medical Journal, 314, 1613–15.CrossRefGoogle ScholarPubMed
(1999). The performance of doctors: the new professionalism. The Lancet, 353, 117.CrossRefGoogle ScholarPubMed
(2004a). Health service reforms in the United Kingdom after Bristol. Medical Journal of Australia, 181, 27–8.Google Scholar
(2004b). Time for hard decisions on patient-centred professionalism. Medical Journal of Australia, 181, 271–4.Google Scholar
(2006a). A short history of the General Medical Council. Medical Education, 40, 202–11.CrossRefGoogle Scholar
(2006b). New ideas about medical professionalism. Medical Journal of Australia, 184, 204–5.Google Scholar
(1995). A statistical approach to measuring the competence of anaesthetic trainees at practical procedures. British Journal of Anaesthesia, 75, 805–9.CrossRefGoogle ScholarPubMed
, , and (2004). Attitudes of doctors and nurses towards incident reporting: a qualitative analysis. Medical Journal of Australia, 181, 36–9.Google ScholarPubMed
(1998). Competence, self-regulation and the public interest. British Medical Journal, 301, 1740.CrossRefGoogle Scholar
, and (1999). To Err is Human: Building a Safer Health System. Washington: Institute of Medicine.Google Scholar
(2004). Eighth Report of the Victorian Consultative Council on Anaesthetic Mortality and Morbidity. Melbourne: DHS Victoria.Google Scholar
, , and (2004). Comparison of three methods for estimating rates of adverse events and rates of preventable adverse events in acute care hospitals. British Medical Journal, 328, 199–204.CrossRefGoogle ScholarPubMed
(1985). Florence Nightingale on public health nursing. American Journal of Public Health, 75, 181–6.CrossRefGoogle Scholar
, , et al. (1996). A regional intervention to improve hospital mortality associated with coronary artery bypass graft surgery. Journal of the American Medical Association, 275, 841–6.CrossRefGoogle ScholarPubMed
, and (2002). How important are role models in making good doctors?British Medical Journal, 325, 707–10.CrossRefGoogle ScholarPubMed
, , and (2004). Bullying among doctors in training: cross sectional questionnaire survey. British Medical Journal, 329, 658–9.CrossRefGoogle ScholarPubMed
and (2005). Health care safety: what needs to be done?Medical Journal of Australia, 183, 529–31.Google Scholar
(2002). Lessons from the Australian Patient Safety Foundation: setting up a national patient safety surveillance system – is this the right model?Quality and Safety in Health Care, 11, 246–51.CrossRefGoogle ScholarPubMed
Shortell, S. M. (1995). Physician involvement in quality improvement: issues, challenges, and recommendations. In Improving Clinical Practice, ed. and . San Francisco: Jossey-Bass, pp. 205–28.Google Scholar
, , (1998). Assessing the impact of continuous quality improvement on clinical practice: what it will take to accelerate progress. The Milbank Quarterly, 76, 593–624.CrossRefGoogle ScholarPubMed
(1998). All changed, changed utterly. British medicine will be transformed by the Bristol case. British Medical Journal, 316, 917–18.Google Scholar
, , and (2003). Risk-adjusted sequential probability ratio tests: applications to Bristol, Shipman and adult cardiac surgery. International Journal for Quality in Health Care, 15, 7–13.CrossRefGoogle ScholarPubMed
, and (2001). Adverse events in British hospitals: preliminary retrospective record review. British Medical Journal, 322, 517–19.CrossRefGoogle ScholarPubMed
(2004). Doctors mistrust systems for reporting medical mistakes. British Medical Journal, 329, 12.Google Scholar
, , , , and (1995) The quality in Australian healthcare study. Medical Journal of Australia, 163, 458–71.Google Scholar
and (2005). The safety of Australian healthcare: 10 years after QAHCS. Medical Journal of Australia, 182, 260–1.Google ScholarPubMed
Accessibility standard: Unknown
Why this information is here
This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.Accessibility Information
Accessibility compliance for the PDF of this chapter is currently unknown
and may be updated in the future.
- 1
- Cited by