There’s an arms race for transparency in health care. Check out the Brigham and Woman’s Hospital in Boston. They made news by rolling over to publicly reveal a delayed cancer diagnosis. Call-out culture meets medicine in a showy display of clinical vulnerability. If you listen carefully you hear them hyperventilating at Propublica.
As The Brigham and Women’s makes a public case of its transparency, the question is whether this moves the chains. We agree that errors happen in health care. If we recognize that there are processes in place to deal with adverse events, then public displays of diagnostic self-deprecation perhaps create more visibility than value.
To their defense, public understanding of how hospitals handle errors (M&M) has value and a discussion about our processes is worth the time. Beyond this dialog, however, does the Brigham and Women’s disclosure set a precedent? And should every hospital launch a media event around their errors?
It’s hard to imagine that the confidence-through-disclosure of vulnerability scales with each glossy press release. But I would submit that if The Brigham and Women’s is as serious as their release would suggest, they might showcase everything.
Consider the outcome that follows a young resident who orders a medication with the decimal point misplaced.
- The pharmacist catches the error and changes the order.
- The pharmacist doesn’t catch the error; the nurse catches it and has the order changed.
- Neither the pharmacist or the nurse pick it up and the patient has an adverse event.
Perhaps all three events should be publicly disclosed in some kind of mega Sunshine act-like repository of radical transparency. A federally mandated quality and safety hall of shame. But in the end, where’s the value?
The more compelling question is what are the things that a hospital or a profession should be trusted to handle on their own? Is there anything that a hospital can and should be trusted to handle without the obligation of a press release?