Organizations must have transparency in order to create a true culture of patient safety. But it takes strong leadership to overcome the barriers to transparency ingrained in healthcare culture so that organizations can be open about errors and mistakes that harm patients and make changes in their systems to keep them from happening again, argue four members of the National Patient Safety Foundation's Lucian Leape Institute.
"Organizations need to implement systems and a structure to support open communication, and that can only come from the top--from the executive leadership and the board," wrote Robert Wachter, M.D., of the University of California San Francisco; Gary S. Kaplan, M.D., chairman and CEO of Virginia Mason Medical Center in Seattle; Tejal Gandhi, M.D., president of the Institute; and Lucian Leape, M.D., chair of the Institute, in the Health Affairs blog post.
The Institute's latest report, "Shining a Light: Safer Health Care Through Transparency," defines transparency as "the free, uninhibited flow of information that is open to the scrutiny of others" and offers more than 30 recommendations for leaders of organizations, clinicians and patients, and regulatory and accrediting bodies. Among those are seven steps leaders can take quickly and at low cost to begin moving their organizations toward greater transparency:
1. Create a culture that supports transparency at all levels
2. Review comprehensive performance data frequently and actively
3. Provide patients and family members with reliable information in a form that is useful to them, including access to their medical records
4. Include patients in interprofessional and change-of-shift bedside rounds
5. Promptly provide patients and families with full information about harm resulting from treatment, followed by an apology and fair resolution
6. Provide organized support to patients, families and the clinical staff involved in a safety incident
7. Share lessons and adopt best practices from peer organizations
In their blog post, the four patient safety leaders point out two examples of healthcare organizations that have recognized the benefits of greater transparency and taken steps to achieve more openness. The University of Michigan Health System pioneered a program that called for the disclosure of medical errors and issuing an apology to patients and families. The result: A decrease in malpractice claims and settlements--two fears surrounding full disclosure.
Ohio Children's Hospitals Solutions for Patient Safety allowed the sharing of data and outcomes among a group of eight pediatric hospitals in Ohio to identify the most serious types of harm to patients and to use methods and an emphasis on safety culture to drive healthcare improvement. It has since grown to become a national collaborative and boasts a 40 percent drop in the number of events of serious harm in member hospitals.
The blog posting follows on the heels of the release last week by the National Patient Safety Foundation of new guidelines for investigating medical errors, which also emphasized the need for leaders involvement. And if healthcare leaders need a further reason to promote transparency, a study released earlier this year showed hospitals get an actual financial return when they embrace a culture of safety, with Florida-based Adventist Health saving $108 million in three years.