===== Performance Consistency =====

**Performance consistency** refers to the ability of a surgeon or surgical team to maintain a stable level of technical quality and patient safety over time.

In clinical practice, consistency is often more important than isolated excellence. A surgeon who performs reliably across cases offers greater safety and predictability than one whose outcomes are highly variable.

==== Measuring Consistency with CUSUM ====

CUSUM analysis allows for fine-grained tracking of consistency:
  * A **flat or gently declining CUSUM curve** indicates stable, expected outcomes.
  * **Sharp upward trends** may reveal episodic deterioration or variation in technique.
  * **Sudden improvements** may correspond with milestone learning events or process changes.

==== Why It Matters ====

Consistent performance is essential for:
  * **Patient trust and institutional reputation**
  * **Accreditation and quality assurance**
  * **Training program evaluation**
  * **Resource planning and scheduling**

==== Common Causes of Inconsistency ====

CUSUM may reveal performance inconsistency due to:
  * Fatigue, shift overload, or burnout
  * Variability in case complexity or patient factors
  * Learning phase or lack of supervision
  * Equipment changes or protocol deviations

==== Goal of Surgical Monitoring ====

The ultimate objective is to achieve **low-variance, high-quality performance**. CUSUM supports this by helping to:
  * Detect instability early
  * Intervene before complications accumulate
  * Validate improvements over time