Surgical Outcomes Monitoring and Improvement Programme ( <scp>SOMIP</scp> ): Surgical outcome research, audit governance and change management—Highlights from a session in the Annual Scientific Meeting of the College of Surgeons of Hong Kong and Conj

Abstract Background Surgical outcomes monitoring has evolved from periodic retrospective audits to risk‐adjusted benchmarking systems that support governance, quality improvement (QI) and research. The Surgical Outcomes Monitoring &amp; Improvement Programme (SOMIP), launched in 2008 across all public hospitals under the Hospital Authority in Hong Kong, provides annual risk‐adjusted outcome benchmarking and an infrastructure for local improvement initiatives. Methods This meeting report synthesizes the content of three presentations delivered at the RCSEd/CSHK Conjoint Scientific Congress session on 30 November 2025. Source materials comprised the speakers' slide sets and the session video‐recording (excluding the Q&amp;A session). Results Speakers reviewed the professional and historical foundations of outcomes monitoring from Codman's ‘end result’ philosophy to contemporary risk‐adjusted surgical report cards, emphasizing the Donabedian structure–process–outcome framework. SOMIP was described as a risk‐adjusted benchmarking programme adapted from the ACS NSQIP model, providing department‐level signals to trigger system diagnosis and QI. Potential unwanted effects—league table thinking, morale harm, risk aversion and gaming—were highlighted, with the session advocating that outcome monitoring becomes an ally when embedded in a just culture and paired with actionable process improvement. A cluster‐level case study from the New Territories West Cluster (NTWC) illustrated how early ‘poor outlier’ signals in 30‐day mortality catalysed multi‐layered interventions, including strengthened senior presence, structured mortality review, multidisciplinary quality circles, ICU liaison pathways, sepsis control and pneumonia prevention workstreams, and workflow integration of a risk calculator to support perioperative triage and optimization. Conclusions The session positioned SOMIP as a mature surgical outcome research and audit platform that can strengthen surgical governance and drive improvement where data credibility, fair risk adjustment and supportive implementation are prioritized. Future opportunities include deeper integration into clinical management systems and the development of surgical data science–enabled decision support, coupled with safeguards to mitigate unintended consequences.