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Bench marking and performance management in neonatal care: easier said than done!
  1. D Field1,
  2. B Manktelow2,
  3. E S Draper2
  1. 1Department of Child Health, University of Leicester, Leicester, UK
  2. 2Department of Epidemiology and Public Health, University of Leicester Medical School, 22–28 Princess Road West, Leicester LE1 6TP, UK
  1. Correspondence to:
    Professor Field, Department of Child Health, Robert Kilpatrick Clinical Sciences Building, University of Leicester, Leicester LE2 7LX, UK;

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Methods of monitoring perinatal services are reviewed

It seems now to be a “given” that all medical practitioners should be able to demonstrate the quality of what they do (performance management). Similarly there is an expectation among the public that the medical services available to them should be able to produce evidence of the fact that they are as good as those elsewhere (bench marking).1,2 Neonatal care as a specialty has had a long tradition of trying to “monitor performance” both through the use of routine statistics (such as population based neonatal and perinatal death rates) and with more detailed data from ad hoc local and regional surveys.3 Despite this experience, satisfactory national data to underpin performance management and bench marking remain some way off. Providing data that can be appropriately understood and interpreted by the lay public remains a particular challenge. The lack of progress is the result of a number of factors and these are discussed below.


The word outcome implies a measurable end point, and within neonatal care there has been a longstanding debate about the value of short term outcomes, such as death, versus later outcomes, such as health status at 2 years, in determining “good performance”. Whereas the former allows a quicker estimate of performance, data on later morbidity provide a much clearer picture of what is being achieved, albeit in a time frame that is less likely to be relevant in guiding changes to early neonatal management. From the parents’ point of view, they wish to know both the chances of their baby surviving and the risk of any later problems with development, although there is great variation in how parents view the latter information. Although all neonatal services aim to ensure that every baby requiring intensive care survives and is …

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