Moreover, whenever transparency has been introduced as a safety intervention, it has effectively improved performance. For example, the rapid disclosure of adverse events, accompanied by honest explanations and fair and timely settlement offers, has led to improved patient and clinician satisfaction. Unfortunately, transparency is one of the most underused vehicles to improvement in the healthcare system.
Explore This IssueJuly 2016
The National Patient Safety Foundation’s Leap Institute held a roundtable discussion to determine the role of transparency in the context of patient safety. The resulting report, published in 2015, identified four transparency domains: 1) between clinicians and patients, 2) between clinicians, 3) among organizations, and 4) between organizations and the public. These domains are highly interrelated, and the report recommended that transparency should be emphasized in all of the domains. The report noted, “If transparency were a medication, it would be a blockbuster, with millions of dollars in sales and accolades the world over. While it is crucial to be mindful of the obstacles to transparency and the tensions—and the fact that many stakeholders benefit from our current largely nontransparent system—our review convinces us that a healthcare system that embraces transparency across the four domains will be one that produces safer care, better outcomes, and more trust among all of the involved parties. Notwithstanding the potential rewards, making this happen will depend on powerful, courageous leadership and an underlying culture of safety.”
The report also included many recommendations, some of which were targeted at specific domains and some of which are relevant to all stakeholders. For example, the report recommended that all financial and nonfinancial conflicts of interest be disclosed. Additionally, it suggested that patients be given reliable information in a form that they would find useful. Such information would include data that represent the perspectives and needs of patients and families.
Transparency will be enhanced when organizational cultures emphasize it at all levels and work to share lessons learned and adopt best practices from peer organizations. Emphasis should be placed on accurate communication with patients in particular, and with all stakeholders in general. Dr. Eibling emphasized, specifically, transparency among organizations and the public. He also cautioned, “The business of transparency is strong medicine, and it needs to be dispensed carefully.” Transparency requires competency and an appropriate environment to support its use.
As the need for transparency increases, stakeholders are shifting and redefining themselves. The ACA has facilitated consolidation in the form of hospital mergers and acquisitions. Physicians are being integrated into hospitals, and reimbursement is being transformed from fee-for-service to value-based. On the one hand, consolidation can reduce the amount of competition and cause healthcare costs to soar. On the other hand, the shift toward a population-based health model has tended to lower costs.