League tables, risk assessment and an opportunity to improve standards

The implications of the Secretary of State’s approval of the introduction of league tables for cardiac surgeons are discussed. Surgeons are to be ranked according to mortality rates for first-time coronary artery bypass graft operations. It is questionable whether anybody will gain from this information: the focus of surgeons’ attention is transferred from patient care to self-preservation. The introduction of league tables in New York State has resulted in surgeons being reluctant to operate on higher risk patients and in secondary referrals of patients out of the State. League tables also encourage the manipulation of risk factor status.
Many factors other than the individual surgeon’s skill influence the quality of care and patient outcomes. These factors include the patient’s status, the timing of surgery, the surgical team, equipment in the operating room and post-operative care.
An alternative to the punitive process of public reporting is the application of continuous quality improvement to healthcare. This starts from the position that most negative outcomes are due not to individual failures but to failures of process and systems.