News: Lucian Leape Institute – Transparency Is the ‘Magic Pill’ for Improvement

Dr. Lucian Leape is a leader among those who urge clinicians and organizations to talk openly about their mistakes, disclose harm done to patients, and apologize promptly and sincerely. Those activities come immediately to mind when the term “transparency” is used in patient safety. A new report from The Lucian Leape Institute (LLI), Shining a Light: Safer Health Care Through Transparency, looks beyond disclosure and apology and applies the principle of transparency across all dimensions of healthcare. Calling transparency the “magic pill” for improving healthcare (p. xii), the report urges all stakeholders to engage in “free and uninhibited flow of information” (p. vii) for better outcomes, fewer errors, and lower cost.

The report is fifth in a series from LLI that began in 2010. Each report is the result of “roundtable” meetings at which a committee of experts with diverse backgrounds examines a pivotal topic in patient safety. A program of the National Patient Safety Foundation, the Lucian Leape Institute is charged with determining strategies and action plans for large-scale efforts to improve the safety of healthcare.

The new report begins by acknowledging the complexity of healthcare and describing “overarching” barriers to transparency, including fear of conflict, lack of leadership, investment in the status quo, and a paucity of reliable definitions, data, and standards. Those and other barriers return in various guises as the report settles into a thorough exploration of transparency in four different domains—between clinicians and patients, among clinicians, among organizations, and to the public—each with its own expectations, benefits, and obstacles.

• In clinician/patient relationships, full and honest exchange of information enables shared decision making, informed consent, and other aspects of patient engagement that improve care. It also appears to lessen the toxic effects of malpractice litigation.
• Among clinicians, open and effective communication can improve the care of individual patients and patients in general through sharing best practices. Clinicians also benefit when openness allows better peer and organizational support during times of crisis.
• Transparency among organizations refers to sharing lessons about safety, including hazards that are discovered through adverse events, with entities even if they are competitors. This domain also includes participating in patient safety organizations and enabling data transfer such as electronic records and images on behalf of patients
• Being transparent to the public refers to providing consumers with useful information about the quality, safety, and cost of medical services at the level of individual providers as well as organizations.

In addition to analyzing broad strategies for improving transparency and safety, the report issues 39 action items. Organized by domain, the list includes sweeping actions that would improve more than patient safety. For example, taken together, actions one, two, and three recommend that clinicians and organizations disclose all financial and non-financial conflicts of interest and provide patients with reliable, relevant, and user-friendly information.

Action item number four is arguably the most important and supersedes the rest: “create organizational cultures that support transparency” (p. viii). The report recognizes that transparency cannot be separated from what we’ve come to call a culture of safety; each requires the other. In fact, it is easy to imagine that an “uninhibited flow of information” without the moral framework of a culture of safety would be problematic.

The LLI report on transparency opens debate on some of the most important and complex issues in healthcare and hopefully will result in soul searching and improvement across all domains. The report is available for download at http://www.npsf.org/?page=llireports.