More than a century ago, Ernest Codman, a Harvard-trained surgeon, advocated greater data transparency among hospitals and a focus on the results of treatment (which he called the “end results idea”). Codman believed that transparency would promote quality improvement as well as patient choice and empowerment. The theory was that accurate, easily-accessible data would allow organizations and practitioners to compare their data, benchmark, and to learn and improve. Simultaneously, consumers could compare outcomes data to help them make better informed choices about the physicians and hospitals from which to seek care.
Since Codman first proposed a transparent “end results system,” hospitals in the United States and the rest of the world have largely resisted making their data more transparent. To the contrary, a lot of data are protected in secrecy under layers of empty corporate speak and eyewash. Today, the average consumer can get much more useful information about performance and cost in other service industries (hospitality, travel, financial services) than they can in healthcare. In the latter, purchasing decisions are mainly driven by reputation of the hospital, anecdotal reports, and personal preferences and prejudices of the provider, rather than hard data. Surely, this situation cannot be a good thing for patients and purchasers. Without free access to the relevant data, healthcare overall will be less effective, less efficient, less safe, and more expensive.
Some hospitals and doctors have expressed concerns that public disclosure of data, including those on errors and adverse events, may lead to misinterpretation and an increase in lawsuits. These fears are not justified by experience or the available evidence.
Exemplary hospitals, and more specifically exemplary hospital leaders, acknowledge the vulnerability of healthcare providers and systems to human error and try to improve processes. For example, Paul Levy, the former CEO of Beth Israel Deaconess Medical Center in Boston, MA, is largely credited for turning his hospital around by championing quality improvement and patient safety. One of the hallmarks of Levy’s leadership was his unwavering transparency, which built trust and created the foundation for improvement. This case study of Beth Israel Deaconess Medical Center [PDF—2.4 MB] highlights the use of transparency as a tool for quality improvement, which needs to be coupled with accountability. There are other gems from the Beth Israel Deaconess story:
- The potential of quality improvement to dramatically improve a hospital’s financial performance;
- “The strength of an organization is measured not by counting the number of successes, but by its response to failure”; and
- The enormous influence of the CEO on organizational culture.
At the other end of the spectrum are leaders who will hide everything except those things that are mandatory to disclose. But that’s exactly what not to do if you want to get better results. By covering up the data, these individuals forfeit the opportunity to make real progress in quality and safety. Similarly, there are leaders who would knowingly ignore quality issues that have been identified in their organization until the time they expect the next accreditation survey.
There have been numerous calls for greater transparency, from patients, purchasers, and even some physicians. However, it should be increasingly apparent that universal data transparency can only be achieved through regulation and enforcement. Transparency, or the lack of it, is merely a phenotype of an organization’s DNA, which, like human DNA, is impossible to change. Except with a change of leadership.