Public reporting of individual surgeon performance

To the Editor: Last year, three of us made a case for the public reporting of individual surgeon performance information.1 We argued that considerations of safety and accountability strongly justify the collection of individual outcomes data, and that considerations of patient choice make it very hard to argue against the public reporting of collected data. The public trust in health care in Australia has, in the words of a recent MJA editorial, “taken a pounding” as a result of a series of scandals at the King Edward Memorial Hospital, Perth, in 1999, the Canberra Hospital, in 2000, and the Campbelltown and Camden Hospitals in NSW, in 2002.2 We noted that recent developments in public reporting of surgeon performance information in the United Kingdom were driven in large part by the Bristol Royal Infirmary Inquiry, and we warned of the danger of waiting for a scandal like Bristol to occur before acting to improve performance management.

Unfortunately, a scandal, perhaps on the scale of that at the Bristol Royal Infirmary, has now occurred in Bundaberg. Although this scandal is ostensibly about the failings of one badly performing surgeon, it is widely seen as symptomatic of a failure of regulation of health care throughout Australia. The Queensland Health Systems Review, headed by Mr Peter Forster, was established in April this year as a result of public disquiet resulting from the Bundaberg scandal.3 The Premier received the report on 30 September and has recommended a wide range of reforms including increased performance monitoring of a range of health care outcomes (Recommendation 13.2), and the insistence that information on health system outcomes be made public (Recommendation 13.3).

We welcome the review’s recommendations as both a necessary component of a successful system of management of the health care system and a means to begin to restore public trust in the health care system. Unfortunately, we suspect that this may not be enough to restore trust in the system. A system in which a plainly incompetent surgeon has been allowed to continue operating is one where, in the eyes of the public, the performance of all surgeons working within that system is called into question. A public reporting system that provides reliable and valid information about individual surgeons, as well as hospitals’ clinical performance, would be a significant step towards restoring the public’s confidence and ensuring transparency within that system.