Are mortality rates a good measure of hospital performance?
25/02/2014
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
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Professor Black has a point about looking at quality measures but surely this isn’t a question of either / or. The mortality figures ARE helpful in their own way. Professor Bourne’s point about the need to look at a range of measures is well made.
I’ve looked at a range of measures for over 40 NHS Trust hospitals. The Mid Staffs inquiry heard about the idea of mortality ratios being a bit like a smoke alarm – when it goes off you may have a fire but it may be you have just burnt the toast. For trusts with high mortality ratios I have yet to find just burnt toast. For the trusts in the group I looked at, those that had poor mortality ratios had other indicators of problems – such as staff satisfaction, patient satisfaction, efficiency, finances.
So, as a patient, if the mortality ratio is poor, don’t ignore it, chances are the trust is having problems. However, mortality as a measure is a bit like driving the car by looking in the rear view mirror – its all a bit too late by now.
If the mortality ratio is looking OK, it may or may not not be a good sign. If you are the CEO of a trust and your mortality ratio is OK, you can’t be complacent. Looking at a range of measures will help you to know what is happening now. Measures such as the much discussed friends and family test, done well and used properly, can tell you what is happening today, this week. If you ignore them, your mortality ratio in the future may be going up. By which time of course its all too late …….
This point – well made – shows how careful one has to be in drawing conclusions about performance from measures. It’s tempting to leap to a conclusion and the media seem to do this on occasions. It must be tricky for organisations in the public eye such as the NHS to balance the need to set and use performance measures with the danger that they may be misunderstood outside the organisation.