Abstract
At a time where delivering the best quality of care is the raison d’être of the health service, outliers can pose a serious challenge to both clinicians and policy makers.
Methods of outlier detection are highly variable. The collection and assimilation of outcome variables can also be very challenging. Despite this, the publication of surgeon specific data has brought the concept of outliers into the public eye and the consequent punitive action affected upon surgeons can be deleterious to clinician psychology and patient perception. Simultaneously, positive outliers are rarely mentioned and never rewarded.
Moving forward, the use of more objective outcomes, including novel biomarkers and patient-centred data, as well as innovative statistical strategies and management cultures, can positively evolve the healthcare paradigm for the future.
IntroductionOutliers, “a person or thing that differs from all other members of a particular group or set.”(1) Outliers come in all forms and exist in every fabric of our world. Some have hypothesized their occurrence is random, merely a statistical roulette. They are to be acknowledged and glossed over. Others propose there is untapped potential in analysing and studying outliers for the progression and development of society. Could there be a pattern of behaviour to learn, or an algorithm that the ordinary can use to achieve the extraordinary? In a domain as multidimensional as healthcare, and particularly cardiac surgery, it is no wonder that there is a prevalence of outliers, both positive and negative, institutional and individual. Is the study of outliers in the health service an unchartered path for research to further guide policy-making? If so, what exactly can we learn from them?
The renowned Economist, Nassim Taleb, hypothesises that outliers occur randomly, merely a statistical roulette, and that so called “Black Swans” can never be predicted(2). The conflicting opinion is proposed by Malcolm Gladwell: outliers arise when individuals are exposed to observable opportunities in nature and nurture, and there is much to learn from studying them to understand why they occur (3).