Bioethics Blogs

The ethics of DocAdvisor: Is accountability always a good thing?

Dominic Wilkinson @NeonatalEthics

 

In the news this morning, the NHS has released data on individual surgeons’ performance, so called “surgeon report cards”. This represents the latest move towards increased transparency and accountability in the National Health Service. Elsewhere in the media today, there are numerous reports of the UK couple who were apparently charged £100 after posting a negative hotel review on an online website.

These parallel stories highlight one concern about certain types of health accountability: sensitivity to the negative impact of reviews (or poor performance figures) could lead to harmful changes in behaviour. For surgeon report cards, one frequently cited concern is that publishing report cards could lead surgeons to avoid high-risk cases. If surgeons choose patients with lower risk of dying, they will potentially end up with a better report card. However, then the results would be misleading (it would be the equivalent of someone getting a higher mark by choosing to sit an easier test). More worrying, it may mean that some high-risk patients are unable to access surgery.

Should we be worried about the negative effect of report cards on surgeons behaviour?

One reason to be sceptical about this concern is that there are some ways of adjusting performance figures to take account of patients’ risk. Websites like MyNHS publish risk-adjusted mortality rates. This adjusts (at least to some degree) a surgeon’s performance results based on how high risk their patients were. It is a bit like the way that Olympic divers’ scores are adjusted for the degree of difficulty of their dive.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.