On BBC Radio 4’s Today programme this morning there was a discussion about the value of mortality statistics published for NHS hospitals and whether mortality rates are a good measure of hospital performance?
The person who has been asked by the NHS to review their use told the BBC that they can give a misleading picture of a hospital’s performance. Professor Nick Black said: “I think we should be focusing on measures of the quality of care and not on a spurious measure of mortality ratios, which can be altered relatively easily. Personally, I would suggest that the public ignore them.” However, Dr Foster Intelligence – the research group which publishes the statistics – defends the measure, saying it is a useful indicator that a hospital may need to improve.
Therefore, as a member of the public, should you take note of mortality rates before choosing where to have elective surgery? I wouldn’t recommend that you do, for three key reasons:
- You need to be very careful if you rely solely on one figure for measuring performance. We did that with profit in the private sector and learnt that profit can be delivered in the short term by making the business less competitive in the longer term. Banks have paid out billions for mis-selling by focusing on the income from credit protection insurance. One measure can never represent the performance of an organisation!
- Measures can be manipulated. Mortality rates are no exception to this rule. One of the simplest ways is not to treat difficult cases as the risks are too high. For viewers of BBC1’s Holby City, would you want Professor Hope to be doing your heart surgery? As he showed, sometimes you have to be brave and take a risk to save a patient’s life.
- You should never focus solely on outcome measures. You need to understand performance in the fullest sense and understand what delivers the outcomes you are achieving. If you don’t, people will manipulate the data, focus only on one thing and not develop and learn. So in this respect, Paula Higson’s article on “what a non-executive director should know” is a good summary of what we need to do.
Mike Bourne is a Professor of Business Performance at Cranfield School of Management