In the wake of the Bristol children’s heart scandal, the Association of Victims of Medical Accidents lobbied the Labour government to increase NHS transparency. A post-Bristol political directive forced hospital cardiac surgeons’ (in 2001) and then individual cardiac surgeons’ death rates into the public arena (in 2005). This occurred despite the negative evidence base that followed release of surgeon-specific mortality data (SSMD) in four US states in the 1990s. In 1999 Donald Berwick, President of the US Institute of Healthcare Improvement, argued that ‘negative outcomes stem from failures of hospital systems and process, not individuals.’ The actual risk of postoperative mortality depends upon patient factors (comorbidity, frailty, urgency), which interact with the quality of medical and nursing care. In contrast, SSMD convey the incontrovertible impression that one individual bears responsibility for all adverse events. This is equivalent to blaming the pilot for engine failure after a bird strike. It directly contradicts World Health Organization (WHO) policy, which parallels airline safety with surgical team performance. Hence public reporting of SSMD is not a benign issue. It creates serious professional conflicts of interest because the direct route to low mortality is to avoid surgery on the sickest patients. Focus changes from patient care to self preservation. In 2007 the Society for Thoracic Surgery in the US discouraged use of SSMD and advised publication of composite measures of hospital access, process, safety, outcomes and patient experience. This included voluntary (but universally adopted) publication of mortality statistics at hospital level. In 2008 the American College of Cardiology issued a formal document on public outcomes disclosure, in which they advocated use of scientifically valid performance measures at hospital level. They provided clear warning about the