Saturday, September 13, 2008

Transparency, a reprise

The Institute for Healthcare Improvement offers an occasional 2.5 day course for hospital senior leadership teams, which they call their Executive Quality Academy. They admit hospital teams to develop action plans to lead quality improvements in their organizations. (The group above is from Winchester Hospital, a very fine community hospital in Eastern Massachusetts. There were also folks from Stanly Regional Medical Center in North Carolina, the Indian Health Service's Red Lake Hospital in Minnesota and North Dakota, and several hospitals in Florida.) Dr Vinod Sahney, one of the faculty members, asked me to come by this last week and talk about the role of transparency in this kind of effort.

As I did, it occurred to me that recent arrivals to this blog might not be familiar with how I have used it to experiment with reporting of clinical results, with the hope of helping to hold our organization accountable for meeting quality improvement metrics. As I said in an article in Business Week about one year ago:

There are often misconceptions as people talk about "transparency" in the health-care field. They say the main societal value is to provide information so patients can make decisions about which hospital to visit for a given diagnosis or treatment. As for hospitals, people believe the main strategic value of transparency is to create a competitive advantage vis-à-vis other hospitals in the same city or region. Both these impressions are misguided.

Transparency's major societal and strategic imperative is to provide creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.

Rather than repeating my IHI talk here (boring!), I am just going to list below some key posts to which I referred during my session. (Who needs PowerPoint if you have a website!) If you are interested, you can follow them through and get an idea of the journey we have taken during the past two years. As always, I welcome comments on these, but I am also seeking comments from those hospitals that have also tried this approach, so we can learn from your experiences, too.

These things happen -- a description of the point of view, all to often found in hospitals, that a certain level of harm that occurs to patients is "just the way things are."

We saved one person's life -- one of series of posts on our effort to eliminate (yes, eliminate) central line infections.

Teamwork wins against VAP -- one of a similar series on our efforts to eliminate ventilator associated pneumonia.

Aspirations for BIDMC and BID~Needham -- the story of how our Boards established an overall goal for these two hospitals of eliminating preventable harm over the next four years.

Source material -- Detailed background on the material behind the Boards' votes.

Next stage of transparency -- A link to our website documenting our progress, quarter by quarter, towards the goal to eliminate preventable harm.

The message you hope never to send -- How we used transparency to learn from one of the most egregious errors that can occur at a hospital, a wrong-side surgery.


Toni Brayer, MD said...

Paul, I know you didn't write this to get kudos but I must say this post is quintessential "Running a Hospital".
You have set a new standard and clear definition of transparency and every CEO and board across the U.S. should read this and pledge to have the same focus and openness.
Thanks for the links to all of your quality efforts and postings of your results.

Anonymous said...

Thank you, Toni. You are very kind.

Bonnie Smith said...

As IHI participants we too have found transparency to be one of the most important steps taken in healthcare. We now include quality measures on our website ( and have initiatives throughout the hospital as part of our AIP. Others should follow this lead.

Anonymous said...

Transparency should go hand in hand with access to the tools of change. Stepping on the scales publicly may embarrass me about my weight, but without education about what to do about it, a pair of gym shoes, and an extra hour in my day to exercise, I'm likely to be ashamed and confused, but not empowered. Because the costs of transparency are borne by individuals, whereas the benefits are communal, the resources to do better and the rewards for doing so should be as obvious as the exposure is necessary.

Anonymous said...

I think it's wrong to say it is misguided to expect transparency to provide information so patients can make decisions about which hospital to visit for a given diagnosis or treatment. Speaking strictly as a consumer, it drives me crazy to not have access to third-party information when I'm trying to decide where to go or who to see for a particular problem. As I work in the hospital industry, I often put out calls to friends for their inside knowledge and recommendations, but it's not a very scientific way to decide where and from whom to get your health care.

Anonymous said...

You are certainly correct. I don't mean to imply that it would not be nice to have that information. But it currently does not exist. See below at

Jim Accord said...

Is it possible JCAHO and other "watch dog" organizations might use transparency data as a club rather than a tool?

Jim Accord