That happened a few weeks ago when one of our Trustees asked the question explicitly, saying "I understand the power of transparency within the organization, but is it wise to be so open about clinical outcomes with the public? Can we be sure that the incremental value, in terms of staff performance within the hospital, merits the exposure of our warts and flaws to the broad public?"
This is, of course, a legitimate question, in that we live in a very competitive health care environment here in Boston, and we certainly do not want to engage in behavior that would undermine the reputation of the hospital and perhaps hurt its financial performance. My answer had three parts: First, an acknowledgement that what we are doing is an experiment; second, that there has been no evidence at all that it has adversely affected our clinical volume or our standing in the marketplace; and third, that studies of organizational change suggest that public disclosure has extra motivational value in encouraging people to engage in continuous process improvement.
Now frankly, I had no empirical evidence of the last point but was relying on presentations I had heard from MIT's Steven Spear and IHI's Jim Conway on this topic. I trust both of them as experts in this field of process improvement, and both have been extremely helpful to our hospital as we proceed with this adventure.
Then, this weekend, I read a somewhat old article that supports this proposition. It is from Health Affairs and is entitled "Hospital Performance Reports: Impact on Quality, Market Share, and Reputation," by Judith H. Hibbard, Jean Stockard and Martin Tusler. You can read it here. The article concludes, based on several hospitals' actual outcomes, that "making performance data public results in improvements in the clinical areas reported upon."
Intuitively, this feels correct for lots of reasons, but it was interesting to see research supporting the conclusion. I wonder if people reading this know of other studies that reinforce or undermine that result. Please comment.
As a final point, I also want to note that in today's electronic environment, it is virtually impossible to keep data "private" if it is sufficiently distributed to the hospital's staff. So, if you don't want the public to know, don't even tell your own people!