Sunday, 8 November 2015

Transparency is the new black in healthcare

Transparency is a term that is emerging in healthcare. Advocates are championing its virtues, arguing that by making clinical performance information available for analysis, improvements in service delivery can be made [1].
Sadly, transparency carries the burden of a bad reputation, and it’s finding it hard to shake. For most in the healthcare industry, transparency is virtually synonymous with punitive oversight.
The inevitable consequence of this is fear in the industry. Fear of being publicly benchmarked with your peers. Fear of consumers taking their business elsewhere. Fear of litigation. Fear of an authoritarian administration cracking down on “rogue elements”.
And it is this fear that is preventing clinicians directly confronting their performance data, and making important changes to the way they do business.
In a recent post I described the differences in the way healthcare shares information on critical incidents compared with aviation. This is just one example of the limitations our industry has imposed upon itself. Surely the worst possible outcome of a critical incident is for the system to allow it to happen again when it could have been prevented.
But our industry, beaten down by fear of exposure, pulls the blankets over its head and pretends there is no monster under the bed.
The same could be said for our approach to credentialing. And audit. And many other critical components of the quality and safety system.
It’s time to change.
Transparency needs to be reinterpreted. Transparency should no longer be seen as the master ruling over the worker with fear and intimidation, but the individual critically analysing their own performance.
Publicly sharing de-identified information to allow collaborative benchmarking of standards and performance is the ultimate goal, and has been associated with improvements in care [1]. Understandably, not all clinicians will initially feel comfortable with this. For progress to be made, we need to begin at an individual level. Data needs to be made available in digestible formats, in a protected way so that clinicians feel comfortable analysing it, enabling meaningful changes in practice to be made.
Only then will healthcare approach the safety standards example that our aviation brethren have set for us.
About the Author
Dr Todd Fraser is an intensive care and retrieval medicine specialist, podcast editor of the Society of Critical Care Medicine, and founder of Osler Technology, a clinical performance platform for acute healthcare providers.
Reference :
  1. The Perceived Impact of Public Reporting Hospital Performance Data. Joanne M. Hafner, Scott C. Williams, Richard G. Koss, Brette A. Tschurtz, Stephen P. Schmaltz, Jerod M. Loeb. Int J Qual Health Care. 2011;23(6):697-704