Benchmarking with Patient Outcomes — Unmasked Surgeon Comparisons within a Learning Community for Continuous Improvement

Patient-reported outcome measures (PROMs) are increasingly applied in clinical practice to improve quality of care and patient outcomes. To date, however, little is known about their use for peer comparisons of performance between clinicians, which the authors refer to as benchmarking. In this study of cataract surgeons, benchmarking was implemented through a stepwise approach: (1) Before benchmarking, each surgeon could not access their performance data or compare it with that of their peers; (2) once benchmarking began, all surgeons' identities and individual results became visible to their peers. This benchmarking design was intended to create a learning community free from judgment or stigmatization, drawing each surgeon into a collaborative dynamic of continuous improvement. The authors hypothesized that surgeons within such a benchmarking community would be encouraged to modify their surgical indications, improve their patients' average outcomes, and reduce the volume of procedures without meaningful patient benefit. Between 2021 and 2025, the authors analyzed a benchmarking community of cataract surgeons practicing at four institutions in France. The benchmarking model included voluntary participation, patient involvement, improvement cycles, and respect for patient-surgeon autonomy in clinical decision-making. Dashboards allowed surgeons to compare their PROMs, clinician-reported outcome measures (CROMs), and case-mix-adjusted results. Access to the benchmarking dashboard was supplemented through noncoercive, nonpunitive quarterly meetings with peers to discuss individual and community results, enabling improvement cycles. The authors analyzed data from over 2600 patients with complete PROM and CROM data and found that five times more surgeons modified the surgical indications they used during benchmarking than before benchmarking - 10 of 24 (42%) versus 2 of 24 (8%). The authors also found that only surgeons who actively consulted the benchmarking dashboard modified their surgical indications. Among those who modified their surgical indications during benchmarking, the average postsurgery health gain score of their patients increased by 22% (from 28.7 before to 35.1 after modifying the indications), and the rate of patients without meaningful benefit decreased by 34% (from 19% to 13%). The differences were similar when compared with performance before benchmarking, which yielded a 21% increase in average health gain scores and a 35% decrease in the proportion of patients below the meaningful outcome threshold. These findings support the potential of unmasked peer benchmarking to improve patient outcomes, reduce unnecessary procedures, and advance value-based surgical care.