Public Disclosure - Friend or Foe?
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There was a front page story in the Boston Globe the other day with the following headline: “Errors Test Openness At Beth Israel Deaconess.” The story was about the decision made some time ago by BIDMC CEO Paul Levy to be totally transparent with his own team - and with the public at large - concerning the hospital’s success - or lack of it - in eliminating medical errors. No one disputes the fact that Beth Israel puts far more of its successes and failures in reducing medical errors right out there for all to see - either through its own public reporting, or through Levy’s blog at www.runningahospital.blogspot.com. But this has led to public disclosure of some embarrassing moments over the past year, as the hospital has fessed up to a number of tragic incidents involving patient care. For the record, I serve on the BIDMC Board of Trustees - which is NOT the hospital’s governing board. The Trustee Board is an ancillary board to the Board of Directors, and many trustees serve on a variety of hospital committees. My wife also delivered three children at the BIDMC. I’m not a completely disinterested party.
The Globe story goes on to quote one expert - Jim Conway from the Institute for Healthcare Improvement - who says that Beth Israel’s safety record is as solid as any other hospital’s in Boston, but since the hospital talks about its mistakes and then makes them public, it seems more mistake-prone. This, as the headline suggests, is the price of openness.
Far be it from me to tell the media how to do their job, but it seems to me they got the story exactly backwards. Instead of writing a front page story about the reputational risks the Beth Israel is taking by publicly reporting on its campaign to reduce medical errors, shouldn’t the media - and the Globe especially - be demanding similar openness from the rest of the region’s hospitals? To its credit, the Globe has gotten into some very high stakes food fights over the years with a number of public and private sector institutions over the public’s right to know. I would think this issue - medical errors that can and do involve life and death situations - would qualify as a high stakes, public right to know type issue.
In the meantime, Paul Levy says he thinks the ”bad news” risk to BIDMC is worth the gain associated with a public approach to process improvement. He says disclosure brings intensity and focus to his own organization as they identify and deal with medical errors, and he believes that over time, the public will respect and appreciate the candor his team brings to such a sensitive question.
If the comments on www.boston.com are any indication of public sentiment on this issue, BIDMC’s in good shape. The comments are overwhelmingly in favor of a more public and transparent approach to error reduction. Me too.
Absolutely right, Charlie. On the e-patients blog, which is ALL about the empowered-patient point of view, I wrote How can we have informed patients, if hospitals won’t inform?
As that post says, there’s more at stake here than just “right to know.” The more I study healthcare’s knotty problems the more I see the importance of letting everyone know what the cold hard internal realities are. Very important.
I agree with you, Charlie. I was trained in hospitals that held the majority view (hide everything to reduce legal risk) and the result was that nothing proactive was done to correct the processes that led to the errors in the first place. Paul has it right. I hope others will follow suit.
Charlie - While I agree with Paul’s efforts with respect to transparency, it should be noted that local non profit hospitals such as BIDMC are protected by the state’s charitable immunity law that limits damages against hospitals to $20,000. Physicians have no such cap on their exposure and this transparency may result in more aggressive malpractice cases against them. I think you almost HAVE to have malpractice reform in place before you will see true transparency in the Massachusetts healthhcare marketplace. You really can’t blame physicians given the nightmare that they go through during a malpractice case and they largely carry the load here as, again, the non profit hospitals and non profit health plans have limited exposure so the lawyers go after the physicians. Malpractice reform is key to the transparency efforts.
Sean - while I don’t completely agree with your comment, someone who commented on this post on someone else’s blog (Kevin MD) said, and I quote - “Transparency is lawyer Trojan Horse for tort gotcha plundering of all productive entities. It is to be resisted to the death.”
I think that means he agrees with you!
I’ve never met Kevin though he’s a neighbor of mine in Nashua. I have no idea how he finds time to practice, with all the bloggage he spews forth.
But seriously: I understand his concern but what about OUR concern? How can we possibly untangle this immensely complicated and world-class-ineffective mess if we don’t get transparency?
Lives are at stake. Really. I just finished reading Best Care Anywhere, which at the end details what a mess we have because so many aspects are dysfunctional. It won’t be easy but step one, as I said, is to roll up the windowshades so we can start to see what’s needed.
Public disclosure is foe. Myself I would not want anyone to publish my health concerns on TV, or in the Paper. especially if my family didn’t know. That would take all the dignity out of ones’ death. no matter how they died or from what they died of.
Public disclosure and transparency are only a good or bad idea based on the level of understanding of the people who consume such information.
The Greek philosopher and teacher of rhetoric Protagarus said, “A man’s perception is the measure of all things, of things that are that are, and of things that are not that are not.” Welcome to healthcare transparency.
I was lucky enough to help launch the National Patient Safety Agency for the National Health Service in England. In our communication strategy, a major success factor was to aggressively educate the wide range of NHS “stakeholders” about risk–what it is, where it exists, what can and can’t be done about it, what choices people have around it, and so on. In order to understand safety, you must first understand all the dimensions of risk. Given that risk is in the eye of the beholder, people who are well educated on risk can then be accepted as good stewards of safety.
So until the consumers of performance information (media, patients, payers, attorneys, legislators/regulators, etc.) care enough to “understand” risk and the data they are looking at before drawing conclusions or making decisions, it seems to me that transparency can be very risky business. Pun intended.