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).