By Tejal K. Gandhi, MD, MPH, CPPS
|| Tejal K. Gandhi
If you read this column on a regular basis, you may recall that earlier this year, the NPSF Lucian Leape Institute released a report called Shining a Light: Safer Health Care Through Transparency, outlining broad recommendations for greater openness in all domains of health care. The report includes case studies to demonstrate that this is not a theoretical proposition; some individuals and organizations are making significant progress in communicating openly with patients and in sharing outcomes data within their organizations and with their peers.
We took this discussion to the next level at the NPSF Patient Safety Congress in April, when some of those very innovators joined us to present their experiences at an all-day preconference program. If you were not able to be there in person, the next best thing would be to read the Executive Summary that we’ve just published and made available on the Congress web page.
One of the most compelling examples of the value of transparency can be found in the power of collaboratives. In the not-too-distant past, it would have been unthinkable for a hospital to share outcomes data or information about a medical error with another hospital across town. Now, peer organizations, such as those that make up the Indianapolis Coalition for Patient Safety, are doing just that. The leaders of the ICPS member organizations decide what issues the coalition will work on, then workgroups study the literature, develop best practices, and create implementation tools for the members to use in instituting changes in procedures.
The Michigan Surgical Quality Collaborative (MSQC) is an example of how, at the provider level, sharing information can drive improvement. One of the collaborative’s main functions is to serve as a registry for data that are risk adjusted to compare hospitals and surgeons as fairly as possible. Then, teams from the collaborative visit the high achievers to learn and share their best practices. Presenter Mike Englesbe, MD, pointed out that everyone has something they do better than someone else, and “If you ask, ‘Can you tell us why you’re so awesome?’ everyone wants to participate.”
This concept is key: transparency is necessary for learning and improving. Rick Boothman, JD, chief risk officer for the University of Michigan Health System, who led the preconference session, said that at his organization, it is acknowledged that “we should learn from our experiences and hard-wire improvement” into cases where there is an adverse event or unexpected outcome.
Transparency can help us learn, but it takes leadership and a strong commitment to a culture of safety to get to the level of transparency being practiced by our presenters. And, despite the case studies supporting transparency, we have a long way to go. In an informal poll conducted during the session, only 22% of those in attendance agreed with the statement: I’m satisfied with the degree of transparency at my medical institution.
If you are satisfied with the level of transparency in your organization, NPSF would love to hear from you. If not, I would encourage you to read the Executive Summary and the Institute's report to learn more about the individuals and organizations mentioned. And tell us what you think.
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