​Two separate studies published in the February 3 Journal of the American Medical Association (JAMA) found that participation in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) resulted in no significant difference in patient outcomes. One study, by Etzioni et al., examined nearly 350,000 hospitalizations in 113 academic hospitals; half of these were in hospitals enrolled in NSQIP. The researchers found no difference from January 2009 to July 2013 between the NSQIP hospitals and control hospitals regarding rates of complications, "serious" complications, or mortality. The other study, by Osborne et al., examined national Medicare data between 2003 and 2012 and reviewed 1,226,479 hospitalizations at 263 NSQIP hospitals and at 526 control hospitals. This group of researchers identified a trend toward improvement over time that was unrelated to participation in NSQIP. Like the first study, the second found no statistically significant change in 30-day mortality, "serious" complications, reoperations, or readmissions. As the related editorial in the same issue of JAMA notes, "It is implausible to conclude that knowing results is not useful—perhaps essential—for the systematic improvement of outcomes." This author continues: "The most likely explanation for the findings of these 2 studies is that end-results information, although necessary for improvement, is not sufficient, and that the skills necessary to make effective changes in processes and cultures do not yet pervade US hospitals."

HRC Recommends: The findings of these two studies, though discouraging, should not dissuade organizations from reporting their findings, outcomes, and other patient-safety-related learning. The editorial makes the point that the outcome data is only one piece of the patient safety improvement puzzle. Likewise, adopting a culture of safety is a slow, constant process that will not produce results overnight.