Can league tables help ensure the quality and safety of heart surgery?
This depends on the quality of the league tables and the information from which they are constructed. It is easy to place hospitals in order of death rate after a particular operation, but it is much more difficult to interpret such league tables intelligently. The most important feature in any league table is that the data on which it is based are accurate and complete, and, sadly, this is rarely the case. The second most important feature is that the data should be risk-stratified (in other words, a measure of how old and sick the patients are should be included) so that the league table is fair and does not penalise hospitals, which are prepared to accept high-risk patients. League tables, even if they are accurate and risk-stratified, invariably mean that there is always a hospital at the bottom of the league. If we decide to shut this hospital down, the next hospital will end up as the bottom hospital and, if we carry this argument to its logical conclusion, there will only be one
