by Tony Chen

Many of you know Paul Levy, CEO of Boston's Beth Israel Deaconess Medical Center and Running a Hospital Blogger. He has long pushed for more transparency in healthcare and has led by example. He posts comments from staff, quality scores, and previously even asked if he makes too much money.

Well, this is a good moment to revisit transparency. Earlier today, there was an article in the Boston Globe about the various problems that this transparency has surfaced: firings, wrong-side surgeries, and this past week, a maternal death. WSJ piped in on the article this morning as well.

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Some may look at this and say, "See! This is why transparency is not a good idea. Just think of all the negative PR that is coming to this hospital."

But I would have to disagree with that sentiment and stand with Mr. Levy on this point:

Levy told the Globe the hospital will be “judged fairly” over time, even if there’s some “short term adverse publicity.”

"What we were trying to do is demonstrate to the public that we are willing to be held accountable for quality and safety improvements and establish metrics by which we’ll be measured, and to publish our results"

Of course, most hospitals would not be ready to stomach that "short term adverse publicity." After all, for better or worse, stories get etched into people's minds, much more than data or rational explanations. (note: when was the last time you saw a presidential candidate present anything with powerpoint slides?)

Give Mr. Levy some props for taking the long view on transparency. Yes, there will be hiccups along the way. But as you shine the light into the murky, dark corners of the hospital, things get cleaned up. And transparency is basically trusting your patients and treating them like adults - eventually, that transparency will help patients understand a nuanced reality:
1. Hospitals are run by people.
2. People make mistakes.
3. Some bad outcomes are caused by people's mistakes.
4. Some bad outcomes are caused by the way "the system" is set up.
5. Some bad outcomes aren't caused by any mistakes - they just happen.

And all that leads to the #1 thing any hospital could ask for from their patients: trust.

I think this commenter in the Boston Globe says is well:

I had read an article last year regarding a Chicago(?) hospital that was being proactive about their mistakes and encouraging doctors, nurses and staff to directly apologize to patient who were victims of medical errors, such as operations performed on wrong limbs, sponges left in after surgury etc. The policy was to appologize, then help make amends (pay for correcting surgeries etc). Lawers thought this would lead to more lawsuits because it required admitting to mistakes. Reality was, less lawsuits were filed and less damages paid. Most people just want 1. the truth 2. a way to deal with the mistake. 3. make sure the mistake was acknowledged so it is less likely to happen again. Transparency is a very good thing.

Two questions that I have yet to resolve:
1. When does transparency cross the line and become TMI (too much information)?
2. What does transparency look like if you're not "leading" with transparency (the way BIDMC is)? "Forced" transparency does little to build trust, right?