Home » Research Projects » Managing Medical Performance: A Pilot Study to Investigate the Impact of Surgical Performance Upon Clinicians and Managers
Open heart surgery?
What happens when the mortality rates of cardiac surgeons are made public?
Does transparent reporting of performance data improve the performance of public service professionals? Public reporting of hospital death rates has been adopted in several states and countries in recent years, and within the UK mortality rates of surgeons in Scotland have been publicly reported since 2005 and the mortality rates of hospital units in England from 2008. When the Society of Cardiothoracic Surgeons began publishing mortality rates of cardiac surgeons in England on the internet in 2006, it presented an ideal opportunity to explore the difference transparent reporting makes to performance. Though introduced as a measure to improve performance, some people predicted it would have the opposite effect, with surgeons eschewing clinically difficult cases to make the numbers look better. Surgeons themselves long resisted disclosure of mortality rates on those grounds until newspapers in Scotland and England lodged freedom of information requests for the data to be published.
This project will explore two years of experience of publication of the mortality rates of cardiac surgeons in England, looking at published evidence of performance and exploring the attitudes and perspectives of various players in the medical world to transparent performance reporting.
What the research means to policy-makers and the wider community?
- Regulators and policy-makers, both in the UK and beyond, will benefit from this study’s examination of how local attitudes and practices (e.g. notions of performance) shape and are shaped by regulatory regimes, particularly with the subsequent more general adoption policy of transparent performance reporting in England.
- Published performance data has captured the public imagination and there has been much media debate as to the merits of such an approach, but there is little in-depth research evidence on which to base these debates.
This is an in depth qualitative study based primarily in the cardio-thoracic unit of a single hospital – St George’s Hospital Trust in London. The research team will use a variety of methods to uncover how clinical performance is managed at all levels of the delivery chain. The research comprises:
- Approximately 30 semi-structured interviews with healthcare professionals from clinicians (consultants, junior doctors and nurses), through hospital managers, to representatives of regulatory and policy-making organisations; for instance, the General Medical Council and the Department of Health.
- The observation of 12 clinical team meetings and 3 clinical governance meetings. The team’s ability to observe clinicians talking about and acting upon clinical performance issues gives them a unique opportunity to generate observational data on the everyday workings of the practices and processes of performance, which would usually remain hidden.
- Regular meetings with cardio-thoracic surgeons at the St. George’s Hospital Trust.
This will enable the researchers to build up a detailed picture of the attitudes and practices of different stakeholders to performance management. They will be able to identify areas of consensus and difference and highlight the consequences, including those that are unintended, of differing clinical and managerial strategies to performance management.