Why is it so difficult for hospitals to be transparent?

January 29, 2014

More transparency with regard to results of hospital treatments remains a problem Full disclosure is still rare and often needs to be imposed. Indeed, in the results discussion we are only aware of three types of figures: good, bad or none at all. In the absence of transparency a reference is made to hospitals and medical specialists. But is this justified? Is it really human error or is technology letting us down?

Anything for positive figures

Hospitals love to share good news. This also applies to positive treatment results. Hospitals that announce poor results of their own accord do not exist. This apparent transparency naturally has all kinds of reasons and serves interests other than those of the patient. Critics of transparency also point this out. The urge for excellent treatment results could lead to a negative patient selection. Risky treatments for seriously ill patients may be rejected to ensure the figures remain positive.

Personally I am not so worried about that. The vast majority of physicians working in the Netherlands genuinely have the interests of the patient at heart. The condition is that physicians can continue to autonomously and independently assess their patients in the spirit of the Hippocratic Oath. In this context the free establishment of medical specialists is really not that bad yet.

Poor figures

If results of certain treatments fall below the mark, it is often common knowledge in the hospitals themselves. The suspicion of inferior results 'hangs' in the air. Professionals suspect it, management suspects it and if it is a long-term problem, then eventually patients probably suspect it too. The moment that 'suspicion' turns into 'evidence' and 'action' is crucial. It requires an organization to adopt a proactive attitude. But actively searching for errors and poor results is not an intrinsic element of 'hospital culture'. We celebrate good results, we prefer to ignore poor results - or worse still - we try and justify them in all kinds of ways.

No figures at all

Lastly there is the category of 'no figures'. It is unacceptable not to be aware of your results. As though hospitals have no idea how they are doing, that's how it comes across. This requires some explanation. In recent years healthcare has become significantly more complex. Large amounts of new (information) technology has found its way into our hospitals and this has led to a flow of measurable parameters. However suppliers still manufacture their software and equipment in such a way that there is no free exchange of vital data between the systems such as medical history, current medication use, blood pressure, examination results, X-rays or blood values etc. The systems do not communicate with each other! How user-unfriendly and unsafe for patients do you want it to be? Worse still: hospitals and medical specialists simply accept this situation! Unfortunately it is a global problem. We invest billions in unsafe hospital technology worldwide every year!

Transparency is essential

Johns Hopkins University professor and intensivist Peter Pronovost recently used the following comparison: "Imagine that Boeing was building a new type of plane. When assembling the landing gear they ask the supplier about the communication process between the landing gear and the cockpit. Do you really think that Boeing would be satisfied with the response that the pilot just has to slide open the window and check if it is lowered?" That is actually what we demand of professionals on a daily basis: does the equipment do what it is supposed to, do all the other devices also know that and can we control it? In the meantime several manufacturers have recognized their responsibility and have concluded an agreement related to exchange and openness. This requires monitoring because: transparency is essential

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