Monitoring obstetricians' performance with statistical process control charts.

OBJECTIVE: The main objective of this study was to pave the way towards proactive, continuous assessment of individuals and hospitals by demonstrating the application of evidence-based competency standards in maternity care using statistical performance monitoring.

DESIGN: Retrospective study using data routinely collected by a large maternity hospital.

SETTING: A large teaching hospital.

POPULATION: Clinicians who routinely perform either amniocentesis or ventouse deliveries.

METHOD: As a 'proof of principle', we have used statistical process control (SPC) charts to compare the observed complication rates for amniocentesis and ventouse delivery with the expected complication rates based on published data.

MAIN OUTCOME MEASURES: The recorded complication rates for amniocentesis and ventouse delivery.

RESULTS: The SPC charts identified significant variation in complication rates within the team and showed the ways in which prospective data can be used to provide continuous feedback to individuals on their performance.

CONCLUSION: The study shows that statistical performance monitoring and, in particular, the use of control charts can be a valuable tool in the continuous assessment of individuals and the healthcare service being provided. The control charts provide a more immediate indication of current performance and provide an alternative to performance-based league tables for the presentation of yearly performance data.