Wednesday, January 19, 2011

Dear JC, give everything away for free

An article by Nina MacLaughlin in the Boston Phoenix entitled "Unlocking Knowledge" reminded me of the extraordinary step taken by MIT a decade ago -- a decision to offer course materials online, free to the world.

Here are the introductory excerpts:

Back in 2000 . . . the MIT faculty had to answer two questions: how is the Internet going to change education? And what are we going to do about it?

Distance learning was about to take off, and there was money to be made. Some MIT professors were already in the habit of posting their course materials online so that students could access them informally. But when monetizing this practice became a possibility, people got concerned that the business model ran counter to the school's mission — a commitment to generate, disseminate, and preserve knowledge.

So they took a step back. "We said, 'Let's stop thinking about money," says Stephen Carson, the director of external affairs of MIT OpenCourseWare, "and start thinking about what we can do to create benefit.' " They asked themselves: what's the Internet good at? (Spreading information widely.) What's MIT good at? (The classroom experience.) The faculty drew up a 10-page report making a case for why the conventional distance-learning model wasn't the right route to take. On top of that report — a one-page memo with a bold statement: let's give everything away for free.

Wow. The result was OpenCourseWare, the Web-based publication of virtually all course content from the graduate and undergraduate subjects taught at MIT. Notes MacLaughlin,

The site now welcomes an average one million visitors per month with the tagline: "Unlocking knowledge, empowering minds. Free lecture notes, exams, and videos from MIT. No registration required." It's a system that means Kunle Adejumo, an engineering student at Ahmadu Bello University in Zaria, Nigeria, can supplement and complement the materials and experience he's getting at his own school, which has limited resources and computer access.

It also means that any interested human can click on the course offerings — pick, say, "Problems of Philosophy" — and select whatever lecture topic might be of most interest.

Let's now view a contrasting approach. The Joint Commission, the main accrediting body for hospitals, recently created a Leading Practice Library. This is an outstanding idea. As the commission conducts its accreditation surveys, it encounters many excellent practices in the hospitals it reviews. The idea of the library is to share these stories more broadly.

But read this description and note the implicit exclusion:

The Leading Practice Library is a complimentary tool available to organizations that are currently accredited or certified by The Joint Commission. The documents in the Library are real life solutions that have been successfully implemented by health care organizations and reviewed by Joint Commission standards experts. The Library was built from solutions that organizations have contributed that support patient safety and quality health care. By accessing the Library link, which is located on each accredited organization’s extranet page, users can browse through specific topics of interest related to their own organization and browse as many documents and topics as needed at any time.

Did you catch it? You have to be a subscribing organization to get access to these helpful stories. Why not, like MIT, open them up to the world? If the library would be of value to accredited hospitals, wouldn't it also be valuable to individual patients and consumers who are involved in their own care or who are working as advocates to improve the health care system in general? Would it not also be useful to private practice physicians who refer patients to hospitals, so they could ask possible referral sites if they have considered these best practices? And, of course, wouldn't it be of value to the thousands of doctors, nurses, lab techs, rad techs, trainees, and others in subscriber hospitals who do not ordinarily know (or even know to ask) the password needed to get into the JC's website.

Also, these case studies could provide fodder for fascinating academic work on process improvement. You could imagine the Joint Commission creating alliances with medical schools and the like to have professors and student study them and write journal articles or white papers that elicit even more interesting things from the cases.

Having met a number of the JC surveyors, I know that this work is an outgrowth of what they have been doing informally for a number of years--sharing the best practices they themselves observed or heard about from their peers. I would guess that the surveyors would be pleased to know that the results of their work are being more broadly distributed.

If that were not enough reason, let us recall that the JC does its work on behalf of the federal government, serving as the accreditation body for Medicare. As such, it is not just a private organization. It is more quasi-public in nature. How could we justify limiting the accessibility of government-sponsored work products in an era of transparency?

Finally, on the business front, when it comes to quality and safety, broader distribution of ideas and programs would also add value to accredited bodies for the fee they pay the Joint Commission. Look at Institute for Healthcare Improvement, with its absolutely free Open School, which gets tens of thousands of viewers. It has not hurt and has probably helped IHI's programs that are revenue producing.

So dear Joint Commission, take a leaf out of MIT's book. Give it away for free. Make it easy for anyone to read.

And if you really want to be social media savvy, check out this last thought from the Phoenix story:

What MIT OCW offers is the content. The school is now pairing with the social learning network OpenStudy, which offers the interactivity to create opportunities to engage with other learners. So when you're scratching your head over a single-variable calculus problem, you can connect with others taking the same course and puzzle through it together.

Imagine the potential!


Anonymous said...

Paul, if this is your opening salvo as an advocate for patient-centered care, then I like it! You are absolutely right. Even better, making these practices freely available for both discussion and implementation may finally provide the spark to accelerate the criminally slow progress in patient safety in this country (yes, I am repeating myself from another post).

I, too, dealt with the JC for years as a member of our hospital's medical executive committee. I too challenge them to lead, not follow, in this effort. It is time.

nonlocal MD

Dale Ann Micalizzi said...

Paul, you are absolutely correct! It has been extremely difficult not having access to many publications and sentinel event reports that could very well have improved progress sooner. Transparency of knowledge for all citizens-what a concept of learning together.

Thank you,

Kathi said...

Most of everything, keeping the content for those registered does not let others learn from best practices, particularly in small hospitals and hospitals abroad.

Keith said...

While it may make great sense for this information to be shared, our capitilist, competitive system makes it more economically beneficial not to share this information with would be competitors. Unless you align incentives for hospitals to make it more beneficial for all to give away this information, then you cannot realistically expect this to happen. Furthermore, you might argue that to do so will discourage institutions from innovating at this level, knowing any investment made to better quality will be quickly disseminated to competitors. You are asking what would be the equivalent of saying Toyota must put on line all its best practices and ideas for other car makers to cherry pick.

While we persist in this perception that competition drives quality (maybe not the case in terms of hospitals), it may not be the best model for the health care industry or for the patients it serves. Need to change the model first before you can expect a different result.

Paul Levy said...

Sorry, I don't accept that. When it comes to safety and quality and reducing harm to patients, there is no place for competition. I have never, ever seen a hospital withhold such information from others in the competitive geography.

Anonymous said...

Paul, When I look at the MIT OCW--at least at Sloan School Graduate courses--most of the courses and syllabi are years old...what am I missing?

Pat Mastors said...


Thank you for once again putting a stake in the ground for transparency. And yes, it is frustrating, lamentable and wrong that a quasi-government agency with so much capacity to help, limits access to such revelatory and potentially life-saving information. It is tantamount to an army field surgeon who develops a life-saving procedure on the battlefield, and keeps the knowledge to himself.

However I wonder if, until things change, a "work-around" might be called for. Seems to me, when the town hall isn't available, resourceful and committed people can always pitch a tent. In other words, people and organizations that want to share knowledge can find another gathering place. The Joint Commission may have copyright on the text, but they don't own the ideas.

Might there be another, more accessible platform where institutions and people culturally driven to promote patient safety can freely exchange best practices? Of course it would need to be led by a high-profile, proven leader within the medical community, whose leadership is also embraced by patients, advocates and families. Perhaps the "Best Practices Blog"? Or "Running a Patient-Centered Hospital."

Just a thought...

Cari Oliver said...

You're right, Paul. How can we contact them to put this fabulous idea to advance patient safety and quality healthcare in front of them?