9th Conference European Sociological Association

RN19 Sociology of Professions

2009-09-03 15:30:00 2009-09-03 17:00:00 Thursday, 3 September 15:30 - 17:00 The Complex Shaping of Professional Practice Building I, Auditório 2

Open Heart Surgery. The impact of performance data in cardiothoracic surgery

In recent years public reporting of mortality rates has been adopted in several Western countries as a way of measuring performance of surgeons. Within the United Kingdom the mortality rates of surgeons in England have been recorded since 2008.

The aim of this research was to explore the impact of performance measures on the working practices and relations of cardiothoracic surgeons, perceptions of change in professional autonomy and levels of inter-professional trust. We also wanted to gain an understanding of the rationale of those within public health organisations involved in implementing these measures.

The study used in-depth interviews with cardiothoracic surgeons from a hospital in Southern England and also observed their mortality meetings and surgical procedures. Additional interviews were undertaken with several key members of government and public health bodies involved in the development of performance measurements.

Our research suggests that key members of public bodies involved in developing performance measures feel that risk adjusted mortality rates are a necessary step in identifying surgeons who perform below average. They also feel that publishing surgeons' mortality rates provides transparent accountability to the public. However, they also recognise that few patients view published performance data and that the methods used to measure performance and interpret data are constantly evolving and open to interpretation. Our interviews and observations with cardiothoracic surgeons suggest that responses to the introduction of performance data are mixed ranging from enthusiasm to a sense of unease particularly in relation to professional autonomy and levels of trust between and within the medical professions involved in cardiothoracic surgery. The use of mortality rates may also incentivise inexperienced surgeons and trainees to avoid high risk elective cardiac surgery. More worryingly, some surgeons feel that an over emphasis on mortality rates hides issues surrounding the quality of surgical procedures, the skill base of surgeons and ultimately patients' access to complex elective cardiac surgery.

These findings suggest that current efforts to use mortality audit data as a way of measuring surgical performance contains areas of contention in its production and use. This has implications for future cardiothoracic surgeons, surgery and patients.