Table 2 Themes, sub-themes and excerpts from the participants

Conceptual

Subjective measurement

‘Getting patients to fill out forms is grossly inaccurate in my book…the patient 9 time out of 10 wouldn’t understand what hip pain is’ (S9)

‘There is some subjective element but it is a reasonably validated objective assessment’ (S2). ‘Well they are partly objectified, aren’t they?’ (S11)

‘I suppose the difference maybe with my results is the difference between the maybe more objective measures and the subjective measures’ (S5)

PROMs V Satisfaction

‘Patient satisfaction in a sense is a balance between what their expectations were beforehand and what they achieved afterwards’ (S10)

‘You know there is one outcome there on how much the patient likes the outcome as I like to call it’ (S2)

‘When they are not perfect, they manifest that by saying they are quite poor’ (S7)

PROMs V clinical data

‘Clinically I see very very very few problems and very few dissatisfied patients…that is just wrong. I am sorry I just can’t accept that’ (S10)

Methodological

Focus and variability

‘You should concentrate on operations that have dubious results’ (S8)

‘The increments between each surgeon are tiny …I mean your spread there between top and bottom is only six points’ (S7)

Timing

‘To see if there was any differences at four to six weeks’ (S4)

‘The other thing is the timing is critical because one would generally not measure anything in hip surgery and knee surgery for at least one year’ (S11)

Choice of measures

‘That score has issues with validity for certain age groups’ (S1)

‘The patient might perceive it as a complication but it is not, it is part of the normal process’ (S8)

‘You know it has to be patients with a problem after surgery that is directly related with the surgery’ (S10)

Interpretation

‘Unless I was able to compare myself against somebody else who does things quite differently’ (S2)

‘I mean strictly speaking someone that is at the tail end should be at the tail end in all three’ (S7)

Validity (data quality, case-mix adjustment, sampling)

‘Something is wrong somewhere: either they have problems and they are not telling me or else there is something odd in data collection’ (S10)

‘Even if you adjust them it is not going to give you the proper information’ (S1)

Practical

Time

‘If I had time, maybe. I don’t have time. I mean, I have continuous ideas…and am…let’s say resolutions to measure outcomes better and more often and all the rest of it but we don’t have the time like and we don’t have the staff’ (S11)

Support

‘No interest. No support. No help. No funding’ (S2)

‘We don’t have anything strictly audit related because the big problem with the hospital audits is the information gathering is poor’ (S7)

‘You need generally a political will to get it because it can achieve nothing but to cost them more’ (S2)

‘You need software, you need somebody to analyse it’ (S3) ‘…that takes help, statistical help’ (S4)

Attitudinal

Value

‘There have been a lot of high profile problems in recent times and maybe these kind of problems would have been spotted sooner if we were collecting this type of data’ (S5)

‘You see your patients and they are happy but in general terms you don’t know how you are performing compared to your peers’ (S4)

Undecided

‘That is kind of a relatively disappointing figure, I would have thought and not just mine, I think the overall is kind of a little bit disappointing. Why it is? I am not sure’ (S3)

No value

‘I just think there is a lot of effort being put in there for not a lot of surgical gain from my perspective’ (S8)

Impact

Impact

‘I am going to try and do it better’ (S4)

‘I went off for a few days and started thinking about things so even though my results would appear not to be brilliant, it was very beneficial for me’ (S7)

No impact

‘I seem to be in the middle there and I wouldn’t be changing what I do on the basis of it’(S2)

‘Unfortunately, it does not provide me with one iota that helps me make my next score any better’ (S10)