Last week was Patient Safety Awareness Week, and it's time to recognize the "secret sauce" for any successful effort to improve health care quality: transparency. That's something both sides of the aisle should be able to get behind.
We have a long way to go. Choosing a doctor or hospital is one of life's most important decisions, but you will likely find more detail about the quality of, say, toasters on the market than you will about health care providers. That is not an accident. The idea that health care should be transparent is a fledgling movement, with some powerful opponents. Health industry lobbyists are collectively among the most well-funded interest groups in Washington, and they have succeeded in slowing the pace of change.
But they haven't stalled it completely, thanks to the determination of coalitions of consumer and business advocates, as well as some enlightened health care providers and policymakers. The Centers for Medicare and Medicaid Services (CMS) in particular has taken unprecedented steps to use its leverage to create a culture of transparent public reporting. Through all its efforts, more and more quality and safety data are reaching the light of day. And that's good news for consumers.
Progress in the Private Sector
United in their common goal of driving transparency in the health care sector, a multitude of organizations have already pointed the direction for transparency initiatives. They have assembled data into useful and engaging online tools to help consumers make informed decisions and have pointed out data that is missing but desperately needed by consumers. A new independent study in Health Affairs analyzed the four most prominent and widely-used tools to rate hospitals: the Hospital Safety Score, U.S. News & World Report, Consumer Reports and HealthGrades. The authors found that each of these tools considers different aspects of hospital performance, and each one reaches different conclusions as a result. Some tools look at mortality rate for certain surgical procedures, some consider readmission rates, and some look at a mix of management practices and patient outcomes for particular conditions or procedures. (In full disclosure, one of the tools analyzed, the Hospital Safety Score, is a letter grade issued to hospitals by my nonprofit, The Leapfrog Group, and is focused exclusively on errors, injuries, accidents and infections.)
Based on the findings, one of the study's authors, Dr. Robert Wachter, a prominent patient safety guru (and volunteer expert at my organization) from the University of California, San Francisco, suggests consumers consult more than one rating when making decisions about hospitals. This is sound advice. Hospitals are complex places, and a hospital may have a world-class cardiac unit but a mediocre obstetrics program. Even hospitals with uniformly great surgeons might have a high rate of errors and infections. And just as consumers weigh such factors as airbag placement, console design, and gas mileage when purchasing a car, health care consumers should consider as much information as possible when choosing where to receive care.
Missing and Hidden Data
So what information should patients have access to when making these crucial decisions?
Business advocates and consumers have a long wish list of data that is largely hidden from public reporting. In addition to more nuanced and comprehensive data on hospital safety, here are a few items consumers should be able to easily access online but cannot:
- Track record of individual surgeons (i.e. mortality rate, complication rate, etc.)
- Hospital nurse staffing levels
- Accreditation survey findings
- Patient-reported perspectives in real time
- Medication error rates
- Rate of misdiagnosis (a bigger problem than you might think)
- Rates of unnecessary procedures, by doctor and by hospital
- Clinician perspectives on the quality and safety of the institution they work in (i.e., would your doctor or nurse send their family member to their hospital?)
Some of this data is shielded from public view by law. Some is shielded by standard practice. And some is not collected because scientists haven't put the resources into figuring out how to measure it.
But change isn't just on the horizon anymore -- it's here. Dr. Wachter is leading the charge for more openness among his colleagues. He recently co-chaired a multi-stakeholder roundtable at the respected Lucian Leape Institute of the National Patient Safety Foundation, which issued an exceptionally bold call to action on transparency last month. The report said health care's culture of secrecy needs to change, and it made a series of recommendations for far greater transparency among doctors and nurses, between health organizations, and with patients and the public. This report should be a playbook for the new Congress; transparency is a cause that cuts across partisan lines.
This Patient Safety Awareness Week, let's be more than aware -- let's be vocal about the change we'd like to see. Consumers entrust their lives to the health care industry. The stakes couldn't be higher for our families, and we are entitled to know how the system really works.
A version of this post was first published on Forbes.com and can be seen here.
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