The use of statistical process control methods in monitoring clinical performance

Abstract
To the Editor: Thank you for the opportunity to endorse the comments made in the correspondence by Morton in the August 2003 issue of the International Journal for Quality in Health Care [1]. We agree wholeheartedly with the proposition that systems problems underlie the costly error rate in health care. We are also grateful for the recognition of the system benefits and advantages inherent in the training model employed in the Department of Perioperative Medicine at Barwon Health [2]. To extend our model to the ‘bad apples’ analogy, we would see ‘bad apples’ and some ‘good apples’ volunteering to be made ‘better apples’ in our training system. This helps to dispose of the sensitivity/specificity debate, which we agree can become sterile in a judgemental environment. We would caution against this and direct our efforts to the exposure of specialist anaesthetists and health care students to optimal role models within their profession, while reducing exposure to negative role models wherever they might exist in the health care industry [3].