Dr Foster's case notesMonitoring changes in hospital standardised mortality ratios Hospital medical care has become more complex than it was in the days when there were few effective treatments available.Now many more healthcare professionals may be involved in the increasingly complex care of an individual patient, but the possibilities for error have increased.The Bristol Inquiry, w2 Harvard medical practice study, w3 and the Institute of Medicine's report To Err Is Human w4 have all drawn attention to the level of adverse events in hospitals and the need to avoid unnecessary deaths.Since January 2001 Dr Foster has published hospital standardised mortality ratios (HSMRs) based on routinely collected hospital episode statistics (HES) for the major acute hospitals in England.In 2000 Walsall Hospitals NHS Trust had an HSMR of 130, the highest of all main acute hospitals in England (30% above the value for England as a whole, which is 100).Its medical director and others formed seven clinical governance groups to implement changes in clinical disease areas: heart, malignant, gastrointestinal, respiratory, renal, diabetes, other vascular groups, trauma and
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Jarman et al. (2005) studied this question.