The USA and UK have focused largely on improving standards of care according to national best practice. Yet increasingly healthcare systems are looking outwards to compare performance at an international level in the hope of answering “Are we providing the best healthcare possible? If not, how can we improve?”
The majority of current international comparisons are based on a range of high-level, population-based, indicators of health system performance for example, life expectancy or vaccine uptake. The literature comparing surgery is sparse, but such specialty- level comparisons may offer novel insights into how surgical care is organized and delivered.
This thesis aims to address different aspects of benchmarking surgical quality and performance between the USA and UK as a platform for understanding the broader topic of international comparisons. The apparent differences in health systems, make comparisons more challenging, but should not limit opportunities for learning.
This thesis starts by systematically reviewing peer-reviewed, published comparisons of surgical performance between the USA and UK. Findings from this review provide a basis for the remaining chapters comparing surgical care from different perspectives; using administrative data to understand different international practice patterns and adoption of technology, using clinical registry data to understand technical challenges in comparisons and finally using patient medical records to outline challenges in data collection across countries. Each study highlights differences between these countries, however international benchmarking is limited by methodological complexity and must be approached judiciously, otherwise this risks misinterpretation, misdirection of efforts to improve, and failure to drive change at a policy or practice level.
In conclusion, this thesis provides an outline of the opportunities and limitations of international comparisons of surgical care as well as future directions for the development of a more robust research approach, with a view to encouraging a culture of international learning and impacting genuine change.