Explaining health system responses to public reporting of cardiac surgery mortality in England and the USA

Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability of the health system. The assumption is that greater transparency will stimulate improvements by clinicians in response to peer pressure, patient choice or competition. The i...

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Bibliographic Details
Published in:Health economics, policy and law policy and law, 2021-04, Vol.16 (2), p.183-200
Main Authors: Exworthy, Mark, Gabe, Jon, Rees Jones, Ian, Smith, Glenn
Format: Article
Language:English
Subjects:
Accountability
Cardiac surgery
Case studies
Decision making
Health care policy
Health economics
Health services
Heart surgery
Medical personnel
Mortality
Organizational culture
Organizational power
Patient control
Patients
Peer pressure
Sanctions
Surgeons
Surgery
Transparency
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Summary:Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability of the health system. The assumption is that greater transparency will stimulate improvements by clinicians in response to peer pressure, patient choice or competition. The international diffusion of public reporting might suggest greater similarity between health systems. Alternatively, national and local contexts (including health system imperatives, professional power and organisational culture) might continue to shape its form and impact, implying continued divergence. The paper considers public reporting in the USA and England through the lens of Scott's ‘pillars’ institutional framework. The USA was arguably the first country to adopt public reporting systematically in the late 1980s. England is a more recent adopter; it is now being widely adopted through the National Health Service (NHS). Drawing on qualitative data from California and England, this paper compares the behavioural and policy responses to public reporting by health system stakeholders at micro, meso and macro levels and through the intersection of ideas, interests, institutions and individuals through. The interplay between the regulative, normative and cultural-cognitive pillars helps explain the observed patterns of on-going divergence.
ISSN:1744-1331
1744-134X
DOI:10.1017/S1744133120000444