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Football leagues have been around for more than 100 years and more recently comparative performance is being analysed for everything from restaurants to schools. Last year the Fat Duck in Bray was named as the best restaurant in the UK, and Colchester Royal Grammar School was top of the league tables in England—pupils there did better in their A/AS levels than at any other school in the country.1 This is obviously a significant achievement, but does it mean that it is a “better” school than others? Data comparing schools only present one part of the picture; no weighting is given to sporting or social development, and while attempts have been made to adjust for cultural and socioeconomic influences by looking for “value added”—comparing the difference in results from primary schools with GCSE performance—these again only interpret academic achievement. The data from schools that do well in league tables demonstrate to prospective parents that the academic performance of the school is good, and aim to reassure pupils, parents, teachers and school governors that things are going well. The position in a league table may help parents and children choose a school, but will usually only be one factor among many.
There are obvious parallels between producing league tables in education and health care, with both agendas being driven by politicians and the media, while finding resistance from teachers and doctors. Over the last few years there has been particular scrutiny on mortality results in cardiac surgery, leading to publication of comparative mortality outcomes following coronary artery surgery, aortic valve surgery and all cardiac procedures for individual hospitals and surgeons.2–7 The issues around “substrate”, type of outcome, analysis and interpretation regarding schools league tables also apply to cardiac surgery mortality outcomes.
WHY MEASURE SURGICAL OUTCOMES?
There are a number of reasons to …
Competing interests: In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. Ben Bridgewater is a member of the steering group of the Northwest quality improvement program in cardiac interventions, a member of the executive committee of the STCTS and a Society of Cardiothoracic Surgeons of GB and Ireland representative on the Tripartite group (SCTS, Department of Health and Healthcare Commission) steering national cardiac surgical audit. Bruce Keogh is the president of the SCTS, and the Medical Director of the NHS.