Making transparency a reality in health care is far from simple. The new LLI report cites significant obstacles but presents a set of specific recommendations.
By Tejal K. Gandhi, MD, MPH, CPPS
|| Tejal K. Gandhi
In a 2009 paper, the NPSF Lucian Leape Institute members called transparency “fundamental to the endeavor of achieving meaningful improvement in health care system safety” (Leape et al. 2009). This month, I am pleased to share news of a new report on the topic. Shining a Light: Safer Health Care Through Transparency argues for sharing of important information—particularly the kind of information that can influence quality and safety.
The report defines transparency as “the free, uninhibited flow of information that is open to the scrutiny of others.” To break it down in the simplest of terms: if a clinician causes harm to a patient, and no one else knows about it, how can we prevent others from causing—and suffering—the same harm?
Yet the report considers the application of greater transparency far beyond the doctor-patient relationship. To truly advance patient safety, transparency needs to occur in four domains both within and outside of organizations: between clinicians and patients; among clinicians within an organization; between health care organizations; and between health care organizations and the public. These domains are interdependent for, as the report states, “If the environment is not supportive of clinicians reporting and discussing their errors, it will be difficult for them to be open and honest with their patients, and unlikely that errors will be reported, analyzed, and shared within the organization or with other organizations.”
Of course, making transparency a reality in health care is far from simple. The report cites very significant obstacles—chief among them being that few health care organizations can claim the kind of safety culture that supports and expects transparency to be practiced at all levels. Other notable obstacles are a lack of reliable definitions, data, and standards for reporting on quality and safety; fear of potential negative effects on finances or reputation; and the objections of individuals who may be benefiting from the status quo.
These are not easy obstacles to overcome, but this report offers more than three dozen recommendations for how we can begin. Moreover, it includes case studies of how transparency is being put into practice—and how some are reaping the rewards.
This new report is the result of two Institute Roundtables—with participants representing every sector of health care—that reviewed the literature, discussed the barriers, heard success stories, and developed recommendations. I hope you will take the time to review the report, share it with your colleagues, and let us know what you think.
Members of the NPSF Lucian Leape Institute Roundtable on Transparency will discuss this new report in a webinar on February 12, 2015, from 12 noon to 1:00pm Eastern Time. Registration is free of charge. Register at: http://bit.ly/LLItransparency.