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Explaining health system responses to public reporting of cardiac surgery mortality in England and the USA

Exworthy, Mark, Gabe, Jon, Jones, Ian Rees ORCID: and Smith, Glenn 2021. Explaining health system responses to public reporting of cardiac surgery mortality in England and the USA. Health Economics, Policy and Law 16 (2) , pp. 183-200. 10.1017/S1744133120000444

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Public reporting of clinical performance is increasingly used in many countries to improve quality and enhance accountability of the health system. The assumption is that greater transparency will stimulate improvements by clinicians in response to peer pressure, patient choice or competition. The international diffusion of public reporting might suggest greater similarity between health systems. Alternatively, national and local contexts (including health system imperatives, professional power and organisational culture) might continue to shape its form and impact, implying continued divergence. The paper considers public reporting in the USA and England through the lens of Scott's ‘pillars’ institutional framework. The USA was arguably the first country to adopt public reporting systematically in the late 1980s. England is a more recent adopter; it is now being widely adopted through the National Health Service (NHS). Drawing on qualitative data from California and England, this paper compares the behavioural and policy responses to public reporting by health system stakeholders at micro, meso and macro levels and through the intersection of ideas, interests, institutions and individuals through. The interplay between the regulative, normative and cultural-cognitive pillars helps explain the observed patterns of on-going divergence.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Social Sciences (Includes Criminology and Education)
Wales Institute of Social & Economic Research, Data & Methods (WISERD)
Additional Information: This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (
Publisher: Cambridge University Press (CUP)
ISSN: 1744-1331
Date of First Compliant Deposit: 27 January 2021
Date of Acceptance: 24 November 2020
Last Modified: 05 May 2023 16:06

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