Table 4 Results of expert interviews related to the component Human of the HIS Evaluation Framework

+ Established infrastructure for developing and disseminating annual reports

+ Annual registry meeting with key stakeholders i) to gain feedback on and finalize annual report, and ii) to discuss potential future directions of the registry, beneficial further analyses etc.

+ Clinicians provide feedback at the annual registry meeting on whether they understand what is presented in the reports accurately and how they would interpret the figures

 - Central efforts to provide data at the level of individual hospitals, surgical teams and surgeons are lacking

 - Led by economists with the aim to save costs rather than to improve quality

 - Reports allow to understand where hospital stands relative to anyone else but not to identify deficiencies in care

 - Lack of resources, incl. Funding, for analysing, disseminating (e.g. user-friendly outputs) and implementing data (e.g. support local staff to understand reports) – most resources went into data collection

 ○ Most reports provide data at level of commissioning groups or NHS trusts

+ Main forum to engage with stakeholders is annual registry meeting which is attended by one clinician representative of each hospital

 ○ Need for tailoring information to and training for respective stakeholder group to ensure best possible uptake

 ○ PROMs data has potential to respond to questions that matter to patients such as What will the outcome be for me? or What are my changes to get better?

 ○ Limited investment to promote information to General Practitioners who would be well suited to use PROMs data for shared decision making and referral behaviour

 ○ Need to get surgeons engaged to examine their practices and outcomes

 ○ Programme provides database for research, however, bureaucracy becomes increasingly difficult and time consuming for accessing the data

 ○ Other stakeholders mentioned include economists, commissioners, researchers, NHS England, etc.