This is a blog by a former CEO of a large Boston hospital to share thoughts about negotiation theory and practice, leadership training and mentoring, and teaching.
I've always enjoyed your posts on transparency. I just read the article as well. One issue presented itself in my mind.At my facility, we also want to be transparent and post information, but it seems so mainly because we are the leader in quality for the area, so it is easier for us to do so. Could this be the case with BIDMC? Is it easy for BIDMC because of high quality already present? Don't you think it would be tougher for a hospital to be transparent when they would just shoot themselves in the foot if they did show their quality information? Surely it would light a fire under the staff, but couldnt it have negative ramifications?
Perhaps the recent move by CMS to no longer pay for certain preventable errors in hospitals will turn out to be a positive development. To the extent that these errors are, to a significant degree, related to internal processes that have room for improvement, then making the institution that owns the process absorb the cost of the error should create an added incentive to improve. If transparency contributes to process improvements that reduce errors, hospitals should embrace it. If they don't, the public (and referring doctors) should start to wonder what the institutions are hiding and why.
Readers might also be interested in Brian Klepper's post "What about Health PLAN transparency?" on The Health Care Blog. Regarding Matt's comment,I think if the hospitals knew they would have to publish the data, they would improve the parameters before publishing it so they could look good. The important part is the mandate to publish it.Paul, I do not live in Boston but am interested in the absolute silence from other Boston health care execs on both this issue and the union drive. Are they hoping that if they ignore you, you will go away, or what? It seems like the ostrich strategy on several fronts - or complacency, equally damaging.
As a Quality person in a hospital, I would like to see information such as this available to patients. However, I feel like I'm caught between the proverbial rock and a hard place. I live and work in one of the few states that have awful peer review laws (there are about 7 or 8 states in this group). Publicly publishing this type of information would be disastrous for us from a litigation standpoint because any information related to errors and/or infections would then become discoverable. In our "suit happy" world, anybody that thinks they were harmed by an error or infection would then sue us. Although there would probably be some justified cases, the majority would not be. But the reality is some of the unjustified cases would win and there go the legal costs out into space because they're already through the roof (with the skyrocketing costs of malpractice insurance).
Matt asked "Is it easy for BIDMC because of high quality already present?" In my experience the quality is there. But I strongly suspect (as a guy who works in marketing, and not in health care) that some players have real discomfort not just because their quality numbers aren't quite as good, but because their prices are also higher (the prices they've negotiated with insurance companies, as covered here some months ago).There could be a rip-roarin' upsetting of the applecart if people saw that some providers were delivering less safe care yet getting paid more for it. My vision is to be able to turn to the hospital equivalent of the auto reliability records in Consumer Reports, and find out that faraway Hospital X is much better than average for a procedure I need, and then decide whether I want to travel there or go to my local hospital, which is just "better than average." Right now we don't have a clue, and that's just plain wrong.
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