Transparency

SUSAN CARR
Editor, susan.psqh@gmail.com

Communities often develop verbal short cuts for concepts that bind them together. In patient safety, “transparency” serves as shorthand for a broad range of activities and programs, including disclosure of errors, patient- and family-friendly access to medical records, and public disclosure of performance data. Used in this way, transparency represents a standard of behavior, a value—something to advocate or aspire to. Transparency is pursued in the hope of building respectful relationships throughout the community and working with others (even competitors) to improve the safety, quality, and efficiency of healthcare delivery.

At its founding, the National Patient Safety Foundation’s Lucian Leape Institute (LLI) identified transparency as one of five concepts that are transformative for safety in healthcare (Leape et al., 2009). LLI’s most recent report (see p. 9 in this issue) provides a springboard for reflecting on different aspects of transparency. The report is thought provoking and timely.  

As this issue of PSQH goes to press, transparency plays a decisive role in a news story that illustrates complex issues alluded to in the LLI report.

In the New England Journal of Medicine (2015), Secretary Sylvia Mathews Burwell announces that the Department of Health and Human Services will accelerate payment reform with ambitious short-term goals for tying Medicare reimbursement to quality and value. HHS aims to tie 85% of Medicare fee-for-service payments to quality or value by 2016 and 90% by 2018.

Discussing HHS’s ongoing strategies for healthcare reform through value-based payment, Burwell includes “enhancing transparency in the health care market” (p. 2). By “transparency” she means publicly available comparative data intended to help consumers shop for healthcare services. Arguably, all of the strategies HHS employs to drive payment reform, including payment incentives, care coordination, and electronic interoperability, involve transparency. They all also demonstrate how challenging it is to follow through on the promise of transparency and reform.

All of these efforts depend on collective commitment from stakeholders (many of whom are competitors) to definitions and standards for measures of quality, outcomes, and value. For example, interoperability requires vendors to work together and share aspects of their products they have been unwilling to share in the past. Care coordination and population health require providers to share information about patients they’d like to keep as customers, and quality measures for payment incentives too often have seemed simplistic and arbitrary. At the same time, when comparative data are available, patients and families often struggle to understand what the data mean and how to use the information.

These examples illustrate the complexity and challenges inherent in the programs and values we include when we talk about transparency, but they provide no excuse for failure to move forward. The more clearly we understand and articulate what we mean when we talk about transparency, the closer we’ll come to achieving our goals.