Consumer-driven health care hasn’t (yet?) delivered on its promise, but one deliverable it has brought to us is transparency.
Still in a stage of infancy, the secret of what transparency can provide is out. Empowering patients to make decisions with useful and relevant information is a good (great!) thing. Making health care organizations accountable is of greater importance.
But like all change, a great many organizations are lagging behind on the movement. In order for transparency to truly work, everyone must share information–it must be the same information and measured the same way in order to be useful.
If you have studied Everett Rogers’ Diffusion of Innovations you know that individuals (and in turn organizations) adopt innovations at varying stages. The first stage is that of the early adopters. Beth Israel Deaconess Medical Center, headed by Paul Levy, has been an early adopter in the world of transparency. The first page on BIDMC’s website prominently displays a link to a page where the medical center details their innovative transparency efforts.
Mr. Levy has long advocated for transparency on his blog. The issue with this innovation is that in order for it to truly work, everyone must adopt it. And to this point, the great majority have not taken the steps that BIDMC has. Mr Levy writes in a BusinessWeek Special Report:
Several months ago, I started to post infection rates and other clinical information about Beth Israel Deaconess Medical Center (BIDMC) on my blog. I suggested, too, that it would be great if other hospitals in Boston would do the same thing. Not for competitive purposes, but to show the public that we were all willing to be held accountable and to demonstrate our commitments to quality improvement.
The response was either underwhelming or hostile. I received arguments against the idea because “the data wouldn’t be comparable from one hospital to the next,” and “the public won’t understand it.”
The Center for Medicaid and Medicare Services has started reporting data through a tool called Hospital Compare where consumers can compare a number of quality measures between hospitals. It’s a great tool. But I’m unsure how many consumers are privy to the knowledge that giving aspirin upon arrival can improve the care for AMI (heart attack).
I don’t think we should resort to combining all quality measures to come up with one less-meaningful all-encompassing measure to rank all hospitals. But we need to make information easier to understand for the average patient. And this is what BIDMC gets exactly right.
Making our organizations completely transparent is seen by some to be a huge risk. That makes one wonder what those organizations could be hiding. Increasing transparency not only helps consumers, it will make us better. And that should be the goal of being transparent: making ourselves accountable to ourselves.
Some more resources here and here, courtesy of Mr. Levy’s blog.
Principle #3: Quality! Make it transparent. Report incessantly. Help (and encourage!) patients to understand it. Look ourselves in the mirror!