But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Monday, September 22, 2008

Sunshine in Worcester

Douglas Brown writes an important op-ed in today's Boston Globe about the experience of his hospital with public reporting of clinical outcomes. His conclusions are below. Please note again: Transparency is not about competition. Is about each institution making itself better and safer, and sharing what is learned across the health care system.

What have I learned?

First, public reporting works. It created a strong incentive to improving our quality. Second, responding to the crisis transparently, while more risky, was the right thing to do. At times, even lawyers must lean into the discomfort of transparency. It was the best course for our patients, our staff, and our community. Finally, humility saves lives. There is nothing more humbling than having to suspend a program. But it taught us to never accept the status quo, to know we can always get better, and to highly value a culture of learning and continuous improvement.

Saturday, September 13, 2008

Transparency, a reprise

The Institute for Healthcare Improvement offers an occasional 2.5 day course for hospital senior leadership teams, which they call their Executive Quality Academy. They admit hospital teams to develop action plans to lead quality improvements in their organizations. (The group above is from Winchester Hospital, a very fine community hospital in Eastern Massachusetts. There were also folks from Stanly Regional Medical Center in North Carolina, the Indian Health Service's Red Lake Hospital in Minnesota and North Dakota, and several hospitals in Florida.) Dr Vinod Sahney, one of the faculty members, asked me to come by this last week and talk about the role of transparency in this kind of effort.

As I did, it occurred to me that recent arrivals to this blog might not be familiar with how I have used it to experiment with reporting of clinical results, with the hope of helping to hold our organization accountable for meeting quality improvement metrics. As I said in an article in Business Week about one year ago:

There are often misconceptions as people talk about "transparency" in the health-care field. They say the main societal value is to provide information so patients can make decisions about which hospital to visit for a given diagnosis or treatment. As for hospitals, people believe the main strategic value of transparency is to create a competitive advantage vis-à-vis other hospitals in the same city or region. Both these impressions are misguided.

Transparency's major societal and strategic imperative 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.

Rather than repeating my IHI talk here (boring!), I am just going to list below some key posts to which I referred during my session. (Who needs PowerPoint if you have a website!) If you are interested, you can follow them through and get an idea of the journey we have taken during the past two years. As always, I welcome comments on these, but I am also seeking comments from those hospitals that have also tried this approach, so we can learn from your experiences, too.

These things happen -- a description of the point of view, all to often found in hospitals, that a certain level of harm that occurs to patients is "just the way things are."

We saved one person's life -- one of series of posts on our effort to eliminate (yes, eliminate) central line infections.

Teamwork wins against VAP -- one of a similar series on our efforts to eliminate ventilator associated pneumonia.

Aspirations for BIDMC and BID~Needham -- the story of how our Boards established an overall goal for these two hospitals of eliminating preventable harm over the next four years.

Source material -- Detailed background on the material behind the Boards' votes.

Next stage of transparency -- A link to our website documenting our progress, quarter by quarter, towards the goal to eliminate preventable harm.

The message you hope never to send -- How we used transparency to learn from one of the most egregious errors that can occur at a hospital, a wrong-side surgery.