Monday, January 24, 2011

Transparency is not marketing

When is transparency not transparency? Answer: When it is marketing.

A recent ad campaign by a well known hospital system suggests that you are better off going to one of its hospitals if you have a stroke because they have a speedy rate of administration of an anti-clotting agent. It is true that rapid administration of this drug is very important.

But the data offered by this hospital system are old, based on the period 2006-2008. According to the Boston Globe, "State officials said that when data for 2009 and 2010 are released next year, they expect the gap between hospitals will have narrowed because of improved care."

Look, no one will argue that you don't get excellent care at this hospital system. Quite the contrary. But to suggest that you will get better care, based on old data, just isn't right. It might even raise unnecessary concern among patients or their families. Imagine, for example, that a loved one is having a stroke and you ask the ambulance to go to a hospital that is farther away because you think that the patient will get faster treatment. The extra time spent in the ambulance might add danger itself.

Also, selective use of clinical outcomes for marketing purposes is a slippery slope. Let's review the issue, for example, of "door-to-balloon" time. The Joint Commission has set a standard for opening blocked arteries with catheterization (percutaneous coronary intervention) within 90 minutes of presentation at an emergency room in a hospital. The hope is to achieve this goal at least 90% of the time.

But one member of this same hospital system only accomplished this standard about 60% of the time for part of 2009. I don't recall a marketing campaign back then that referred to this result.

You cannot be selective about transparency. You have to post the good and the bad. See the VA story below. If you use it for marketing purposes when the numbers are good, you rightfully open yourself up to attack for selective use of statistics.

Let's just accept that transparency is about holding ourselves accountable to a high standard of care and learning from one another, rather than attempting to use it as a marketing tool.


Anonymous said...

Paul, this post contains so many important points it's hard to pick among them. But most frightening was your statement that someone might use old data to send their loved one to a hospital farther away, hoping for faster TPA administration time. I could actually see this happening, especially in your hospital-conscious city of Boston.

Secondly, your statement "you cannot be selective about transparency" cuts right to the heart of the issue, and hearkens back to Charles Kenney's question on your previous post:

Isn't there a compelling -- perhaps even overriding -- moral component to transparency?

Last, in your current position I think you have once and for all answered the question as to whether you persist on this issue in order to gain competitive advantage for your hospital. The answer is, always but clearly now - no.

nonlocal MD

e-Patient Dave said...

I think your lead is a little off-point, actually. When is transparency not transparency? When it is *selective.*

e-Patient Dave said...

Wait ... I'll correct myself. First principles:

Transparency is about "nothing hidden," right? Nothing obscured; see-through visibility. One purpose: "sunlight is the best disinfectant." A related one: defeat denial, conscious or un-. Another, ideally: bring more eyes and minds to the task of improvement.

Correct? Is there more?

If so: I'd say transparency is indeed not transparent if it's selective, because it doesn't fulfill any of the above intents. Otoh, if it does fulfill those intents, why NOT market it, as you did? (You said something like "Isn't it legitimate to advertise that you kill fewer patients?" Of course that better NOT be selective.)

Question: Did that ad campaign assert it was being transparent? (Got a link?)

Eric Brody said...


Your points are well taken. Particularly in healthcare, these "statistics that we use at our discretion" can literally mean the difference between life and death.

Moreover, transparency – whether through your marketing or through someone else's discovery and sharing of the truth through social media channels – is inevitable.

As you suggest, let's hold ourselves accountable to a higher standard.

Eric Brody

Paul Levy said...

No link, Dave. It was a display ad on a popular news website.

Richard Wittrup said...

If we are going to have competition in health care, we are going to have advertising. Nothing in our culture that I know of says that advertising has to be objective or transparent. It is a way to "blow your own horn."

No doubt there need to be some standards to keep things from getting out of hand, but I think the ones you suggest may be unreasonably strict.

Anonymous said...

Mr. Wittrup;

I read your blog also, so I am familiar with and respect your philosophy. However, I think your comment points up the fundamental tension which currently exists between the two primary goals of a hospital - competing financially, and taking the best possible care of patients. I think you are looking at the first goal, and Paul is looking at the second goal. Also, I see this post as indicating that you shouldn't replace one with the other. Sure, trumpet what you do well - but also trumpet what you don't do well, or you will have no motivation to improve it. I don't see that standard as too strict - I only wish health care providers would go ahead and hold themselves to it now, because they will surely be dragged to it in the future.

nonlocal MD