Recording of HSR Webinar – “Why hospital standardised mortality ratios should be avoided Presented” by Nick Black, Professor of Health Services Research, London School of Hygiene and Tropical Medicine”


There is a pressing need to assess the quality of hospitals. Many countries have chosen to use hospital-wide mortality ratios, which have the attraction of simplicity and providing a single measure. But these measures are misleading for five key reasons, all of which will be discussed. Despite criticisms by leading health services researchers in the USA, Canada, UK and Australia over the past two decades, the use of this approach persists. And their use can have harmful consequences for patients, clinicians and managers.
So if politicians and the public insist on deaths in hospital being used to improve the quality of hospitals, how might this be done better? An approach based on in-depth case record review being adopted in several countries will be explored together with rigorous methods for assessing the quality of hospital care.

Biography : Nick Black

After qualifying in medicine from Birmingham University in 1974, he worked in NHS hospitals before joining Save the Children Fund to run a child health programme in Nepal. He then underwent post-graduate training at Oxford, including a doctorate on reasons for the epidemic in surgery for glue ear, before spending three years as a lecturer at the Open University writing a distance-learning course 'Health and Disease' with a biologist, sociologist and economist.

In 1985 he moved to the LSHTM and was promoted to a Chair in Health Services Research in 1995. His main research interests are the use of clinical databases for evaluation and audit of health services (particularly in the field of surgery and critical care), patient-reported outcomes, non-randomised methods of evaluation and, recently, dementia care. He is a trustee of the Intensive Care National Audit & Research Centre.

In 1996, together with Nick Mays, he founded the Journal of Health Services Research & Policy, which they continue to edit and, in 2005, was elected Chair of the newly created UK HSR Network. In 2006 he published Walking London’s Medical History (new edition 2012) to raise public understanding of health services and health care policy through seven walks through London plus a tour of north and east Kent. Since 2007 he has chaired the National Advisory Group for Clinical Audit & Enquiries which advises NHS England. He is also a member of several advisory groups on quality assessment for the DH, NHSE, CQC and QualityWatch.

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