The NHS is launching a coordinated attempt to manage the reaction to this year's Dr Foster Hospital Guide, due next month.
Last year's guide provoked alarm by naming a dozen trusts which it judged to have a poor patient safety record, partly based on analysis of hospital standardised mortality ratios. HSMRs measure the number of people who die at a hospital in relation to the number who would be expected to die after adjusting for factors such as age.
There has been a culture of saying, 'if the HSMR is over [the baseline of] 100, it is bad', and that is really not the case
The validity of the ratio as an indicator of systematic failure is also expected to be debated when the public inquiry at Mid Staffordshire Foundation Trust begins next month.
The trust had been poorly rated by Dr Foster before its problems were exposed by the former regulator the Healthcare Commission.
The Association of Public Health Observatories is responding to those two pressures by issuing a report to all NHS boards warning the HSMR is, "at best, akin to a smoke alarm - it may signal something serious, but more often than not it will go off for reasons unrelated to quality of care". However, it adds: "Like smoke alarms, HSMRs should never be ignored."
The report, seen by HSJ, sets out how boards should interpret and investigate apparently high mortality ratios and highlights shortcomings of the HSMR as an indicator of care quality.
Asked about the dramatic reaction of ministers and others last year Julian Flowers, director of the Eastern Region health observatory and joint author of the report, said: "People treated it more like a fire alarm - they assumed there was fire - when there may not even be any smoke." He said trusts and commissioners also misinterpreted the measure.
“Our experience is people react to the [HSMR] number rather than whether there is actually a problem. There has been a culture of saying, 'if the HSMR is over [the baseline of] 100, it is bad', and that is really not the case."
The NHS Confederation is also working on HSMR guidance, which has been funded by the Department of Health. Acting chief executive Nigel Edwards said that would "broadly endorse" the conclusions of the APHO.
He added: "HSMRs cannot be used in the way they have been. They need to be used with caution."
Professor Sir Brian Jarman, who developed and has championed the HSMR and now works on it with Dr Foster, said he agreed that the indicator was not "the be all and end all". He said it should be taken seriously by managers and investigated where it indicates a possible problem.
He said where high mortality ratios have been investigated they have often revealed problems, highlighting failures at Mid Staffordshire and Basildon and Thurrock University Hospitals Foundation Trust.
Earlier this year Dr Foster and HSJ gave health service managers a chance to input into the setting of this year's Hospital Guide measures.
The DH is hoping to publish findings from its own review of hospital mortality indicators imminently.
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