By Dr. Husam Al-Rumaih, Institutional and Patient-Reported Outcome Measures (PROMs) Lead, King Faisal Specialist Hospital & Research Centre (KFSH)
Most hospitals that measure outcomes follow a familiar sequence. They collect data for several years, refine their methods, build confidence among clinicians, and only then consider showing surgeons how their results compare with those of their colleagues. Transparency is treated as the final stage, a privilege earned once a program feels mature enough to handle it.
At KFSH, we took the opposite route in our cataract outcomes program. From our first measurement cycle, every participating surgeon could see the patient-reported and clinical results of their colleagues. When ICHOM awarded us Level 1 accreditation in October 2026, its assessors singled out this practice and noted that open sharing of individual surgeons’ outcomes is more commonly seen in organizations with longer implementation experience.
That observation raises a question our field should take seriously. If transparency is usually where programs end up, should we treat it as a destination at all? Our experience suggests it works better as a starting point.
The case for waiting is understandable. Early datasets are small. Our first cycle included 46 complete cases, which is not enough to rank surgeons with statistical confidence. Clinicians worry, with reason, that early numbers will be misread as judgments of competence. Leaders worry that exposure will create defensiveness before trust has formed.
But waiting carries its own cost. Data that only a few people see is rarely questioned by many. When results stay within a quality office, the people closest to the care have little reason to examine how the data was collected, whether the questions were understood, or whether the numbers reflect what patients actually experienced. Transparency changes who is paying attention.
Our own first cycle shows the kind of scrutiny this invites. Almost all of our patients reported better vision after surgery. Most programs would simply celebrate that result. During the accreditation review, our team questioned it instead and identified a possible bias: patients who complete follow-up questionnaires in the clinic where they were treated may give more positive answers than they would at home. We are now moving to remote completion and explaining to patients more clearly why honest feedback matters. Open results make this kind of questioning a shared habit rather than the task of a few.
This is the core of my argument. Small early datasets are not a reason to keep results closed. They are a reason to frame them correctly. Surgeon-level results in a first cycle are not a scorecard. They are a shared starting point for asking why outcomes vary and what each of us can learn from colleagues. When the purpose is learning rather than ranking, openness is far less threatening, and the data improves faster because more people are invested in its accuracy.
Patients gain from this approach as well. Patient-reported outcomes exist to place the patient’s own experience of vision beside clinical measures of surgical success. That purpose is weakened if the results stay hidden from the surgeons whose practice they are meant to inform.
Our program is still young. We are moving to digital data collection and integrating outcomes into the electronic health record. As ICHOM recommended, we are also expanding patient involvement and preparing to use outcomes data to help patients make informed decisions about surgery. None of these steps would be easier if we had kept our results private until we felt ready.
My advice to organizations beginning their own outcomes work is simple. Do not wait for maturity to share results with your clinicians. Share them early, explain what they can and cannot tell you, and let transparency build the trust and rigor you are waiting for.
