Surveillance and quality improvement in the United Kingdom: Is there a meeting point?

Recent high profile failures within the National Health Service of England and Wales have highlighted the need for surveillance of quality and performance. Mortality is the most commonly used metric, assessed at the hospital or trust level. However overall mortality can mask where the failures lie and even if they exist. Continuous surveillance at a granular level is needed, especially in surgery where interventions need to be safe, reliable and efficacious but so does the coordination of care along the entire patient pathway with robust protocols and mechanisms in place to prevent 'failure to rescue' and to optimise patient outcomes. There is an expanding body of surveillance tools available for surgical practice and these are beginning to show merit. The Care Quality Commission, who monitor services, increasingly through ongoing surveillance as well as inspections, should work more closely with local quality improvement efforts and become a vector for care excellence, actively involved with spreading best practice throughout the entire NHS and not just for identifying the 'bad apples'. (C) 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.