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Actually, you can compare care quality across the country

February 28, 2011

As long as that country is Sweden.

Quality and efficiency in Swedish Healthcare is a regularly published, highly detailed comparison of care provided across the country. It includes clinical outcomes, patient experience and efficient use of resources. For almost all indicators, the regions or hospitals are ranked.

The reports are excellent. Rigorous and scientific, yet written and presented in a way that makes the information accessible and usable by the non-professional. They pull no punches, showing the variation in quality that exists throughout their system.

This is not just for a few conditions: MRSA infection, pregnancy, mental health, diabetes, stroke care, a range of cancers, joint replacements, primary care, drug prescribing are just some of those included.

In the words of those responsible for publishing this data, the purpose of transparently publishing comparative data is two-fold:
1. Informing and stimulating public debate: “the public, as both patients and citizens, has a right to know about the results of healthcare services that are available to it.”
2. To stimulate and support local and regional efforts to improve healthcare services in terms of clinical quality and medical outcomes, as well as patient experience and efficient resource use.

Comparisons are a powerful way of driving performance improvement

This is of profound importance to the NHS in the UK. The Department of Health and UK medical profession talks a lot about publishing meaningful outcome information and empowering patients – but always seems to come up with reasons not to do so quite yet. Many of us have high hopes that the latest Information Revolution will indeed be revolutionary and the DH could do a lot worse than learn from Sweden’s approach.

The UK public, and the vast majority of doctors, have no idea at all about the quality of care they are getting or giving. How can I find a GP who gives quality HIV care? Which is the best hospital to replace my mother’s hip? Which doctor will give my diabetic child the best chance of a healthy life? These are currently unanswerable questions for those that look to the NHS for care.

Sweden has a much better healthcare system than the UK. The NHS is a long way from giving the care, survival and outcomes that is provided to the Swedish public. However, even in Sweden there is often considerable variation in quality. Re-operation rates for rectal cancer vary between 0 and 15%, MRSA rates (where Sweden is a world-leader in managing such infection) still vary nearly twelve-fold, and far too many diabetics have sub-optimal blood pressure control.

The absolute reality is that variation across the UK is likely to be even greater than in Sweden. Excellent systems have lower variation, poor systems show greater extremes. At least in Sweden they know where their variation is – the poor performers know they have to improve, whilst the excellent work to keep outcomes brilliant and to share their expertise.

Sweden does not just collect this data – they publish it to the public (and professionals) in ways that invite and encourage comparison. It is no coincidence that the countries that “walk the transparency talk” also have the best results and the safest care.
Collecting data is not enough, sharing it with doctors and hospitals is not enough. Publish, publish, publish.

Total transparency is the most effective, fastest and cheapest way to drive up quality.

The public and medical charities have to keep pressing and demanding openness (look at the fuss the papers made about MPs’ expenses, and the impact it had. Where is the campaign for the same openness on health outcomes?).
But the real demand should come from the doctors and medical profession. If the GMC and Presidents of the Royal Colleges are really serious about protecting patients and driving up standards they should be talking loudly about the variance in the NHS, campaigning ceaselessly for comparative outcomes to be published, and working with the Department of Health to make this happen now.

The time for excuses and delays is over.

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