I was reading through other peoples’ blog posts yesterday when amazingly enough, I was here on THCB and came across this straightforward statement by Paul Levy, the CEO of Beth Israel Deaconess Medical Center in Boston.
Of course, many readers are aware that Paul has made news by establishing a blog called Running a Hospital. I think he’s probably taken some good-natured ribbing by his more straightlaced colleagues. But I admire that fact that he’s broken the bounds of decorum and speaks openly about the many tremendously difficult issues that face hospital executives.
While many many hospitals (and doctors and health plans and…) are
still doing everything possible to hold back the transparency tide,
here’s his take:
The main value of transparency is not necessarily to enable easier
consumer choice or to give a hospital a competitive edge. It is to
provide creative tension within hospitals so that they hold themselves
accountable. This accountability is what will drive doctors, nurses,
and administrators to seek constant improvements in the quality and
safety of patient care. So, even if we can’t compare hospital to
hospital on several types of surgical procedures, we can still commend
hospitals that publish their results as a sign that they are serious
Nothing could be truer, or more central to the mission of fixing American health care. This covers a lot of waterfront, is core to much that will occur in the future, and is, by the way, a foundational tenet of Health 2.0.
Thank you, Mr. Levy.
Well, this is where I disagree with Paul on some of his details, because I agree that for individual docs, publishing inaccurate data can ruin a reputation and a practice real quick. However, one can argue endlessly (and deliberately, in filibuster fashion) about how to define what is “accurate” data. Paul’s approach is to get something out there, explain your methodology, and let the reader evaluate it – rather than publishing nothing because there is no national standard. He has done so on his blog before, and has been subject to methodological criticism, which is appropriate. But at least he is doing something! The Cleveland Clinic also publishes their outcome statistics for several departments, even those which are not outstanding.
A lot of this situation is due to the horrible lack of national leadership concerning standardization of quality measurements, on the part of both our government and the AMA and the AHA (American Hospital Association). The latter 2,of course, have a stake in NOT having this data published; hence the endless arguments about what is significant. But look at New York State’s required data on 30 day operative mortality for CABG’s, for instance, and I think you can see a start.
If we believe that the data can not reflect true differences, as the statistical analysis apparently confirms, then the data is not uselful data. Publishing data as important to hospitals and surgeons’ reputation as this when it is fundamentally inadequate to provide the distinctions it is intended to provide is not helpful, more likely hurtful.
Yes, holding institutions accountable is important. But you do it properly, not with shoddy data.
Is that an unacceptable “excuse?”
What’s missing is the long term background from Paul’s blog,detailing the reluctance of many hospitals to post such data under the guise of all the “reasons” (read, excuses) given above. The sad truth is that most hospitals won’t hold themselves accountable because it’s not in their institutional DNA – it’s supposed to be the INDIVIDUAL health care giver who holds themselves accountable. This doesn’t work in a complex interrelated system such as a hospital. Paul’s background, from other industries rather than health care, gives him the proper incredulity at this attitude to push for greater transparency. Although I don’t agree with all his details, I say, go for it, Paul!
We can’t trust the data to give us meaningful information due to statistical limitations, and if it is published it is likely to be misinterpreted by those who feel it reflecs important distinctions. (“if not, then why bother?” might be the common sense reaction by the layperson.)
But it’s important to encourage collection and widespread publication of such data. You know, just because it’s important to hold people accountable.
Am I missing something?
If more hospital execs thought this way about the way their administration was run, health care would rise exponentially without a doubt. Thank you for putting this quote up.
Thanks very much, Brian. You are very kind. I should have footnoted my comments with credit to Jim Conway, at IHI, who really helped crystalize my thinking on this issue. Now, if I could only get him to start a blog . . .