Hospital CEO, Paul Levy, Taking Heat For His Transparency
There is nothing concealed that will not be disclosed, or hidden that will not be made known.
– Mat 10:26
The Internet may be fueling the fulfillment of an ancient prophecy – that there will come a day when nothing can be kept hidden or secret. Of course, early adopters of full transparency are regarded as reckless by some (potentially those who have something to hide?) and laudable by others (though they may be afraid to follow suit). In today’s Boston Globe there is an article about my friend and fellow blogger, Paul Levy. Paul is the CEO of Beth Israel/Deaconess, leading the charge to make hospital errors a matter of public record.
Paul writes about the errors made at his hospital (and many other subjects) in his popular medical blog, Running A Hospital. The blog won the “Best Medical Blog of 2007” award, and he is the first (and perhaps only) hospital CEO that has adopted such a high view of transparency. And for that, I commend him.
In my experience, hospital errors are alarmingly common. When I was training, I witnessed many errors on a regular basis – most of which did not reach the level of a reportable incident, but were alarming nonetheless. I’ve seen patients wake up in the middle of surgery, radiology studies ordered (and read) incorrectly, babies given dangerous medicines by accident, patients being attacked by other patients, multiple falls by the same patient in one night, violence against doctors, inappropriate triage (resulting in delay of care and permanent paralysis), death by delay of care and inappropriate use of narcotics, inappropriate timing of withdrawal of care, and denial of pain medications to patients with kidney stones.
I believe that these events were not addressed directly because the culture in those hospitals was one of secrecy. Staff were under tremendous pressure to protect themselves and the hospital from lawsuits, so they worked hard to hide or minimize mistakes. They were not discussed openly (except in the dreaded “morbidity and mortality” conferences where residents would be publicly blamed and humiliated by their superiors for any error that could not be hidden).
Paul’s approach is not to expand the “morbidity and mortality” conference trials (nor to sick the Spanish Inquisition on his hospital staff – yes that is a Monty Python reference), but to create a culture of honesty and integrity. One where staff are not afraid to point out errors because they know that 1) they will not be humiliated or fired for discussing it 2) something constructive will be done to see that the errors do not occur in the future and 3) overall, the legal risk is lower when mistakes are immediately acknowledged and corrected.
I strongly encourage other hospitals to consider following in Paul’s footsteps – because in an age of camera phones, streaming video, Internet chat rooms, social networks, and blogs -the best defense is offense. Mistakes will come to light – do you want the light to be coming from your own institution, or from somewhere else?
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See my recent guest post at Paul’s blog here.
Addendum: The WSJ blog team has been covering Paul’s transparency strategy since 2007. Do you think reporting errors makes the hospital look “bad” or “good?”
I am intrigued by Mr. Levy’s efforts at BIDMC. As a nurse, we are certainly right in the middle of the error reporting controversy, as nurses often make medical errors, or are implicated in the error process. As with all medical errors, there are multiple factors that cause them – fatigue, communication breakdowns, poorly designed care systems – and I am not sure how I feel about public reporting. Although, it seems transparency is a very enlightening solution, if it’s done correctly. The medical community might also benefit from a new approach to addressing medical errors – one that puts emphasis on cause, and a well defined algorithm for investigation – Just Culture (www.justculture.org).
Right now, our hospital is looking at how to deal with publicly reported data. Groups like Joint Commission already have quality information about our hospital on the internet. What Paul Levy is doing is taking a more proactive approach (instead of a reactive approach). This is definitely innovative with the repercussions (both positive and negative) yet to be played out. I applaud his efforts.