By BOB WACHTER, MD

Paul Levy, the blogging CEO at Boston’s Beth Israel Deaconess Medical Center, has staked his – and his hospital’s – reputation on a culture of transparency. Although no doubt partly driven by Paul’s ethical compass, he must also hope that his unique brand of openness will be good for business.

But will it be?

An article in last week’s Boston Globe left me unsure. In it, reporter Patricia Wen describes Levy’s culture of openness (which has included a unilateral decision to lay bare data on hospital-acquired infections – making him the skunk in the room at Boston hospital CEO cocktail parties – and rapid and forthright mea culpas after serious errors), juxtaposing it against several recent reports of high profile mistakes and tragedies at BI-D, including a wrong-site surgery case and the death of a young woman during childbirth. Although the article raises the possibility that Levy’s openness is enhancing safety, I think most readers will come away with the impression that these high profile errors illustrate that Beth Israel might well be riskier than other hospitals.

I can’t prove it, but my guess is that this impression would be dead wrong. Knowing about the groundbreaking work BI-Deaconess has done in simulation, teamwork training, quality improvement, patient-centeredness, developing one of the nation’s first procedure services and a high quality hospitalist program, and educating trainees in quality and safety science – as well as knowing what I know about the strength of the faculty and housestaff – I find it nearly inconceivable that the hospital is less safe than the average facility, and likely that it’s safer. Plus they have a boffo information technology system, led by their indefatigable (and blogging) CIO, Dr. John Halamka.

The problem, as usual, boils down to the core challenge of measuring patient safety. Until we can figure out how to determine whether a hospital is safe using standardized data and definitions, we remain dependent on self-reports of errors. So a hospital that has convinced its nurses and docs to fess up to mistakes and chosen to be open about these errors to promote organizational change may appear to be riskier than others with fewer reports, while actually being far safer. This is how a hospital like BI-D, which is doing all of these things to an unprecedented degree, can look like an Error Hot-Spot to the media and public while possibly being the safest show in town.

Is this fair? Of course not. Is it predictable? Absolutely. What should we do about it? We must educate the media about this fact: if you are not hearing about serious errors from other hospitals, trust me – it is because you’re not hearing about them, not because they’re not happening. This is a case in which the obvious (I just heard about another bad error from Hospital A – it must be less safe than Hospital B) might well be dead wrong.

As Levy concludes in his blog posting today,

…in today’s electronic environment, it is virtually impossible to keep data ‘private’ if it is sufficiently distributed to the hospital’s staff. So, if you don’t want the public to know, don’t even tell your own people!

If media coverage convinces the Paul Levys of the world that the better, safer course is to play the old game of “hide the ball” – or convinces hospital boards that they shouldn’t hire CEOs who favor transparency – then this type of reportorial error will cost lives, just as surely as medical errors do.

Robert Wachter, MD, is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term “hospitalist” in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as “an epidemic” facing American hospitals. His posts appear semi-regularly on THCB and on his own blog, Wachter’s World.