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Related Experiment Videos

Use and abuse of performance indicators.

P W Skinner1, D Riley, E M Thomas

  • 1Department of Trauma and Orthopaedics, King's College Hospital, Denmark Hill, London.

BMJ (Clinical Research Ed.)
|November 12, 1988
PubMed
Summary

An audit revealed significant errors in healthcare performance indicators due to inaccurate operation classification and data inconsistencies. These findings highlight the need for improved methods in assessing surgical productivity and data collection.

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Area of Science:

  • Health Services Research
  • Medical Auditing
  • Orthopaedic Surgery Assessment

Background:

  • A regional health authority alleged low productivity within a hospital department.
  • An internal audit was initiated to investigate these allegations.

Purpose of the Study:

  • To audit departmental productivity following allegations of low output.
  • To identify and quantify inaccuracies in performance indicators used by the regional health authority.
  • To propose improved methods for assessing surgical performance.

Main Methods:

  • An audit of operations performed in 1983.
  • Analysis of performance indicators, including "weighted number of operations" and "number of major operations per consultant."
  • Comparison of orthopaedic department throughput across districts, evaluating population data and medical staffing information.

Main Results:

  • The health authority underestimated the total number of operations by 5%.
  • Inexact operation classification led to performance indicator errors of 19.8% (weighted operations) and 34.5% (major operations per consultant).
  • Inconsistent population data and incorrect medical staffing data further compounded performance indicator inaccuracies.

Conclusions:

  • Medical practitioners and health authorities must be alerted to the amplification of inaccurate data in performance metrics.
  • Current methods for assessing trauma and orthopaedic surgery productivity are flawed.
  • Recommendations include simplifying surgical operation classification, grading operations by operating theatre time, and utilizing computer programs for data coding.

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