The King's Fund welcomes BMJ published research into measuring clinical performance and calls for further work

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The King's Fund welcomed research published today by British Medical Journal Online which looks at the potential value of identifying performance outliers among gynaecology consultants from data routinely collected in the NHS.

Academics from the University of Birmingham - initially funded by The King's Fund - investigated whether routine hospital episode statistics could be used to identify gynaecologist Rodney Ledward, who was suspended in 1996 and was the subject of the Ritchie inquiry into quality and practice within the NHS.

The research team, led by Dr Mike Harley of the University of Birmingham's Health Services Management Centre, devised a statistical approach that enabled them to compare the performance of 143 gynaecology consultants with the performance of Ledward over a five year period. The aim was to determine if Ledward was a statistical 'outlier' - the analysis revealed that he was in three out of the five years covered by the NHS data. Eight other consultants were also identified as outliers, but the researchers strongly caution against over-interpreting these consultants as having 'poor' performance because there are many valid reasons to explain their results.

Commenting on the findings, The King's Fund chief executive Niall Dickson said:

'Although this approach is at a very early stage and needs further work, it should help us develop better tools for measuring clinical performance. However, we must also realise that screening techniques even when further developed are likely only to raise questions not provide answers – it would be a mistake to draw too many conclusions from this.'

Although this approach currently looks at the performance of gynaecologists, it could be adapted to examine performance in other specialties.

Niall Dickson added: "We would like to see the potential value of this screening technique investigated further. The Department of Health, along with other agencies and regulators responsible for clinical governance - in particular the Healthcare Commission and the National Patients Safety Agency - also need to consider whether there are sensible ways to take this further."

The research report is available online at

Notes to editors

1. For further information or interviews, please contact The King's Fund media and public relations office on tel: 020 7307 2585; mobile: 07831 554927; email: . An ISDN line is available for interviews on 020 7637 0185. For interviews with the research team at the University of Birmingham, please contact Rachel Robson on tel: 0121 414 6681; mobile: 07789 921165; email:

2. Following updates to accommodate the results published today by the BMJ, The King's Fund plans to publish the background work carried out by Dr Mike Harley and his colleagues shortly.

3. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.

4. The Health Services Management Centre is located within the University of Birmingham's School of Public Policy, and has been one of the leading centres for health policy analysis for over thirty years. It plays a major role in research, teaching and development across the UK.