Real transparency in a socialist nirvana? UK releases hospital death rates

By Michael Millenson

In yet more evidence that the transparency revolution is worldwide and not merely a product of American capitalism, comes news that in the UK death rates for specific types of surgery at NHS hospitals are to be revealed. Can this be happening in the single-payer government morass that we’ve been warned off for years? Michael Millenson, one of America’s leading experts in patient safety and quality, gives us his reaction.

This is mind-boggling, if, alas, short on some crucial detail: Is this based on claims data (high-school-graduate-coded administrative information) or clinical claims? If the former, it is impressive, if the latter, extraordinary. For those who believe in the superiority of American medicine, here are a few observations.

First, he who pays the piper calls the tune. If NHS decides to collect this data, it’s done. One also presumes they don’t need an act of Parliament to do so, thereby avoiding at least some degree of political interference.

Second, a leading physician, who actually pioneered releasing clinical data to the public, went on to serve in the Cabinet and continue leading this effort on behalf of the broader public interest. By comparison, our equivalent of a cardiac database, the Society of Thoracic Surgeons database, has strict confidentiality requirements that don’t even allow city-city or state-state comparisons. The exception: a physician can release his own information for marketing purposes.

Third, and most interesting, are these seemingly innocuous sentences. “There were initially fears raised that releasing the information would lead to surgeons avoiding difficult cases which could impact their rates. But agreement was reached on a method to take into account the difficulty of cases and mortality rates are released against the number of deaths expected. Sir Bruce has been working with hospital specialists on a way of rolling out a similar scheme across all areas of surgery and medicine to help patients choose where to be treated.”

You mean a group of physicians sharing a sense of public responsibility and accountability could just sit down and work out this whole “my patients are sicker” problem over a cup of tea or pint of beer? Shocking. Perhaps they could share their methodology with folks on this side of the Atlantic.

Somewhere, Florence Nightingale, who bemoaned the absence of reliable hospital statistics, is rejoicing, and Ernest Amory Codman is looking on jealously.

Meanwhile, Michael also sent in this link to a rather interesting patient safety-conference in the UK starring flesh-eating Uraguayan rugby players, and rope-cutting British climbers.