Table 3. Scenarios using an average hospital case-mix distribution.

		Number of hospitals changing ranks
Scenario	Number of hospitals changing category	No change	1–5 ranks	5–10 ranks	>10 ranks
1	0	14	47	0	0
3	0	38	22	1	0
5	8 (3)	10	41	5	5
7	3 (1)	14	42	4	1

In scenario 1 and 5 the mean distribution of the case-mix variable under study of the 61 hospitals is used to recalculate the HSMR of the hospitals. In scenario 3 and 7 the HSMR of a hospital is recalculated using the mean distribution of the case-mix variable under study over time (2006–2009). In the second column the numbers of hospitals are shown for which the recalculated HSMR crosses a ‘control limit’. In brackets: the number of hospitals for which the HSMR lies close to a control limit (within 2 HSMR points). Columns 3 to 7 show an overview of rank changes of hospitals based on the recalculated HSMR.