Monday, 14 November 2011

Public Reporting of Outcomes - History, Ethics, Keogh and the NHS Reforms

I recently posted why I felt that reporting of the outcomes of an individual clinician was wrong. I believe very strongly however in the principle of outcomes reporting.

The first person to advocate the reporting of outcomes was an American Surgeon in 1910. His name was Ernest Codman (picture) and he worked in Boston. His words were quite prophetic

So I am called eccentric for saying in public that hospitals,
if they wish to be sure of improvement:
must find out what their results are
must analyze their results . . .
must compare their results with those of other hospitals
must welcome publicity not only for their successes, but
for their errors
Such opinions will not be eccentric a few years hence

It has taken several decades for his words to be heeded and then by American cardiac surgeons in New York state. I have embedded this recent supplement article published in the Annals of Thoracic Surgery. This journal is the main publication of the STS (Society of Thoracic Surgeons) , one of the 2 main Cardiothoracic Association in America. It is heavy going in places but is a good description of the history, ethics and philosophy of outcomes reporting.  I think it is gracious of the authors of this article to mention the efforts of British Cardiac surgeons. 
It is the efforts of the STS that Bruce Keogh, current medical director of the NHS and ex cardiac surgeon, has been trying to emulate on a grand scale. These ideas form a lot of the basis of what is in the mind of Andrew Lansley and the current planned NHS reforms.