Mr Graham Copeland is a retired consultant general surgeon whose research and work over the last 30+ years has been dedicated to improving quality in healthcare and outcomes for patients. His work has been recognised nationally and internationally both clinically and managerially and its application has had an enormous and demonstrable impact for saving patients’ lives and reducing harm.
International research
Graham is the inventor of the POSSUM surgical scoring system, the most widely known, published and recognised surgical risk scoring system in the world.
He initially developed the POSSUM system in the late 1980s and since its publication in 1991 he has expanded its application to be validated in all surgical specialties with the exception of cardiothoracic surgery (which will shortly be added). Sub-specialty versions exist for orthopaedic surgery, vascular, colorectal, transplant surgery, ENT, maxillofacial, ophthalmology and upper gastrointestinal surgery. His system is the audit method of choice recommended by all the British Royal Colleges, all the specialist associations of the Royal Colleges and the Association of Surgeons of UK and Ireland. It forms an essential component of the National Clinical Audit datasets for cancer and the national vascular surgery audit. It is also the system recommended by the National Confidential Enquiry into Peri-operative Deaths in England and Scotland and has recently been recommended by Monitor and in Lord Darzi’s review of surgical outcome assessment.
Over the course of 30 years Mr Copeland acted as collator of an international POSSUM database, with a devoted following that ultimately has contributors from 46 countries, and now represents the largest risk adjusted outcomes database of individual patient outcome measures (both mortality and morbidity) in the world. At present this stands at >400million procedures processed. He has provided quality reviews to some 36 countries worldwide, including Argentina, India, Pakistan, Turkey, Australia, Denmark, Germany, Spain, Portugal, Kenya, Saudi Arabia, Qatar, USA, Columbia, Australia and New Zealand. He acts as a reviewer for articles written by these contributors and there have been approaching 350 articles published worldwide about POSSUM over time. He has been a reviewer for the British Journal of Surgery and the Annals of Surgery.
National activities
Graham has had a major interest in clinical audit over the past 25 years and has an international reputation for advising international and local organisations in all forms of clinical audit, both medical and surgical. He was seconded to the Department of Health as National Director for Clinical Audit, and likewise acted for the National Clinical Governance Support Team (CGST) – a part of the Modernisation Agency. During this time he produced ‘The Practical Handbook of Clinical Audit’, which has changed the focus and direction of local clinical audit. It was the most downloaded resource from CGST nationally and became the mainstay of the National Clinical Audit Group (NCAG). It remains the definitive manual for clinical audit providing essential direction on structures, processes, methodologies and priorities for good clinical audit.
He co-chaired the National Clinical Audit Group with Dr J Boyce and acted as advisor to the Healthcare Commission (now the Care Quality Commission) on local and national clinical audit issues. He was likewise an advisor to NICE with regard to implementation and monitoring of compliance.
International activities
Graham has acted as clinical audit advisor to many countries and organisations worldwide as documented below. He was central in advising the Scottish Audit of Surgical Mortality, the Department of Health in Scotland, along with the governments of Germany, Portugal and Singapore as well as organisations in Spain, Sweden, Denmark Ireland and beyond. He has also acted as advisor in clinical audit and clinical governance to the Ministries of Health in Singapore and Hong Kong.
Most recently, Graham has redeveloped these systems to help the NHS with the growing list of patients waiting for surgery after COVID by providing automated clinical triage to put the patients at greatest need first. This has been evaluated independently by NHS England, results in the first year show significant improvements in waiting times, reductions in patients deteriorating whilst they waited (including a corresponding reduction in patients admitted in emergencies), with large savings in bed capacity and ICU capacity, and also in surgeon time, freeing them up to deliver more services.
Graham’s passion for outcome improvements and the reduction of avoidable harm extend well beyond the boundaries of hospital care into the transformation and delivery of healthcare in communities and Life Sciences.
Truly unique, Graham’s work has been winner or finalist in over 30 national and global awards.
Link to POSSUM methodology here