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Hospitals choose to share survey results, the good and the bad, with the public
Could this be the start of a new trend?
It's not uncommon for hospitals to receive requirements for improvements (RFIs) after a Joint Commission survey. What is surprising is that in May, Boston-based Massachusetts General Hospital chose to share this information publicly — not just its accreditation status, but its complete survey results.
The hospital's web site now lists the RFIs found by surveyors in a Q&A format aimed at a lay audience, with the questions "What did The Joint Commission find?" "Why is it important?" "What are we doing about it now?" and "Where are we now?" answered for every RFI received.
"We answer those four questions for each of their findings, and we will be updating the 'Where are we now?' section on a regular basis," says Gregg Meyer, MD, Massachusetts General Hospital's senior vice president for quality and safety. "And for those who want to see the real report, it's right there." (To see a summary of the hospital's RFIs, go to www.massgeneral.org. Click on "Massachusetts General Hospital Joint Commission findings." To view a PDF of the complete survey report, click on "View the redacted version of The Joint Commission's findings about the MGH.")
Why did the hospital do this? "We thought it was the right thing to do," says Meyer. "This took a fair amount of integrity and did incur some risk. But luckily we are blessed with strong enough leadership here that they said, 'That's all true, but this is too important and we have to do it anyway.'"
However, local news coverage focused largely on the problems found by the surveyors as opposed to the openness of the hospital, including reporting on preliminary results that were later overturned. "When The Joint Commission came here, we knew that there were some things that they didn't get right. They have a process that allows you to address that, and we worked through that process," says Meyer. "That is why they do preliminary reports."
However, the surveyors also found some things that did need work, such as medication reconciliation. "The only way to do that isn't with little quiet committees hiding somewhere — what you need to do is get everybody on board and be very open with folks internally," says Meyer. A message was sent to the hospital's 19,000 employees about the surveyors' findings.
Transparency and the media
Not surprisingly, that document got out to the local media, which took a negative spin on the story. "But at the end of the day, we did what was important. I would do everything the same way again, even though we took our lumps," says Meyer. "The outcome speaks for itself — we made improvements that were needed."
Although Meyer believes the hospital was unfairly portrayed by the media, some amount of misunderstanding and negative reaction may be inevitable when a hospital is "transparent."
"That's just the way it is. That is the price we all pay for this," Meyer says. "I think it will take time for reporters to be able to sort this through. There will be a painful transition period, until such time as reporters get comfortable and cover this in a way that really makes sense."
The decision was a big reflection on the hospital's leadership, Meyer asserts. "This was not the quiet and easy way out of this," he says. "For us, it made sense that this was a way we could move our quality and safety agenda forward." After Massachusetts General made its results public, four other Boston hospitals followed suit: Brigham & Women's, Children's Hospital, Dana-Farber Cancer Center, and Boston Medical Center.
According to Andy Whittemore, MD, the hospital's chief medical officer, Brigham & Women's chose to share its survey results because of a belief that transparency is vital in today's health care environment. (To see a summary of the hospital's survey findings, go to: www.brighamandwomens.org.)
Public demand is growing
Quality professionals interviewed by Hospital Peer Review applauded the openness of the hospitals. "Three cheers for the Boston hospitals that released their Joint Commission survey results to the public," says Nancy McLean, RN, BSN, MHSA, senior consultant at Courtemanche & Associates, a Charlotte, NC-based firm specializing in regulatory compliance.
"It was a gutsy thing to do. Being the first to do it is risky but they should be rewarded for their honesty," says Patti Muller-Smith, RN, EdD, CPHQ, a Shawnee, OK-based consultant specializing in regulatory compliance. "Subjecting themselves to scrutiny by the consumer should increase overall trust. Those that do not inform the public may create the opinion that they have something to hide."
The bottom line is that quality information ultimately will become part of the public domain in one form or another. "It is going to happen. It is good to have leaders that are willing to go first to set a model for honesty with the public," says Muller-Smith.
Currently, The Joint Commission's web site lists the last survey date and accreditation status of hospitals, and the Centers for Medicare & Medicaid Services (CMS) Hospital Compare site lists not only the accreditation status of hospitals, but also how that hospital scored compared to other hospitals in key treatment areas.
More sophisticated consumers
In the near future, however, patients will no longer be satisfied with knowing only whether a particular hospital is accredited, predicts Muller-Smith. "We are looking at a more sophisticated consumer population who is going to demand more information," she says. "Unfortunately, the media sometime sensationalizes the data, rather than seeing it as a way to provide continuous monitoring that will protect the public."
If the public is privy to problems found by surveyors, they can be more active participants in the care they receive. "Consumer awareness of specific problems in any hospital allows them to advocate for personal attention to the key area, should they become hospitalized," says McLean.
Most health care facilities have similar problems to those found by the surveyors at the Boston hospitals, notes Kathy Haig, director of quality/risk management/patient safety officer at OSF St. Joseph Medical Center in Bloomington, IL.
"It is courageous of those who are willing to admit to their issues and to be honest in both recognition of the problem and what is being done to address it," she says. "Anyone involved in health care knows there is not a 'perfect' hospital — we all share similar problems due to the complexity of the system."
Boston hospitals paving the way
Although the Boston hospitals apparently tread new ground in making their entire survey results public, other hospitals may soon follow suit. "I do believe this will be a growing trend, partly due to several states mandating public reporting of events, following guidelines similar to that of The Joint Commission, with their sentinel event reporting," says Haig, referring to mandatory event reporting laws in Illinois and Minnesota.
While most hospitals stop short of sharing their entire survey results, many are taking other bold steps to "go public."
"Our facility has provided our local newspaper with our organizational dashboard that includes both quality and safety measures," says Haig. "It was never printed so I believe it may have been a little overwhelming." The system also is working on a public reporting Internet tool. Topics being considered include data reflecting quality, safety and service indicators.
Education is needed
When it comes to the average patient's comprehension of core measures, quality data, and Joint Commission requirements, there is a steep learning curve. "Explanations and education will be necessary so that the general public can understand the nature and impact of the problem," says Haig. For example, the vast majority of people outside the health care field don't realize that medication reconciliation is a problem that most hospitals are struggling with, and may assume that anything less than 100% compliance means a hospital is unsafe.
"The public will not understand that these things occur in most facilities across the country. The challenge is in trying to share information and educate the public without sounding like we are making excuses," says Haig.
As little as six or seven years ago, no one had heard of medication reconciliation or unapproved abbreviations. "As knowledge in health care-related safety improves, we now better realize the potential for harm," says Haig. "I am not saying these variances are acceptable — most definitely not. But these are everyday struggles that we all face to make health care safer."
Although making survey results public isn't yet the norm by any means, it certainly has the makings of a growing trend. "I am not really surprised and predict that this is what is to come," says Haig. "CMS and The Joint Commission have a close relationship in many areas, so I can foresee that working together on this as well. It would also seem that open reporting would be a motivation for ongoing compliance in order to sustain the reputation of the facility." Haig says she personally would feel more comfortable with a hospital admitting to its problems than with one that tries to hide the concerns.
"Many more organizations are going public with their quality results, good and not so good," says Alice Gosfield, a Philadelphia-based attorney and consultant specializing in quality improvement. A related trend is the full disclosure of errors to patients who are harmed.
While there are those who are fearful these developments will incur more malpractice lawsuits, Gosfield counters that making information available doesn't exacerbate the reality of what happened. "Some would say there is no reason to make it easier for plaintiffs' counsel. But operating a hospital out of fear of plaintiff's lawyers is no way to operate."
Hospital attorneys and risk managers may be cringing, but there is a bigger issue at stake, says Gosfield. "I'm sure that the lawyers were very anxious. So what? If the hospital gets sued, that's what they have insurance for. Lawyers shouldn't drive what hospitals do," she says. The point is to create a culture where there is a real desire to always do better, says Gosfield. "[Sharing survey results] contributes to that, and frankly contributes to the public's understanding regarding realistic expectations about what hospitals can actually do."
Being open about safety problems and what's going to be done about them is something hospitals owe the public, Meyer stated. "And I think it's fair for people to go back and say, 'Did you actually do it?'" he says. "I think the public is more ready for this than we give them credit."
[For more information on transparency in healthcare, contact:
Kathy Haig, Director, Quality/Risk Management/Patient Safety Officer, OSF St. Joseph Medical Center, 2200 E. Washington Street, Bloomington, IL 61701. Phone: (309) 662-3311, ext. 1347. E-mail: Kathy.M.Haig@osfealthcare.org.
Nancy McLean, RN, BSN, MHSA, Senior Consultant, Courtemanche & Associates, PO Box 17127, Charlotte, NC 28227. Phone: (704) 573-4535. Fax: (704) 573-4538. E-mail: email@example.com.
Gregg Meyer, MD, Senior Vice President, Quality and Safety, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. Phone: (617) 724-8098. E-mail: firstname.lastname@example.org.
Patti Muller-Smith, RN, EdD, CPHQ, Administrative Consulting Services, Box 3368, Shawnee, OK 74802. Phone: (405) 878-0118. E-mail: email@example.com.]