The inquiry into cardiac deaths at Bristol Royal Infirmary recommended that patients must be able to obtain information on the performance of hospitals and individual surgeons. Since then, cardiothoracic surgeons have been voluntarily submitting figures for publication.
But the arguments for and against publication are finely balanced. Cardiac surgeons in the United States, where public reporting already exists, believe that the system is unfair, as the performance of a surgeon is highly dependent on his or her institution. It may also encourage surgeons to protect their results by avoiding high-risk patients.
The value of such publications also depends on whether the outcome usefully reflects quality of care, the ability to cater for differences in casemix, and whether the publication is designed to facilitate patient choice or show consistency of standards.
In the UK, surgeons have collected simple activity and mortality data for each surgeon for some years. The data is not detailed enough to cater for variations in casemix, so the surgeons have agreed for their results to be compared against statistically derived standards without compensation for casemix. Each surgeon will be measured to see whether or not they meet the agreed standard.
When these results are published later this year, medicine in the United Kingdom will have crossed a threshold into a new era, say the authors. This system is not perfect, but it is a first step towards transparent public accountability.