Medical Musings: How to make hospitals accountable
Transparency should be an important factor in improving medical care in America. C-Level officers in corporations have dashboards that give them information on operations and performance on a moment’s notice.
Hospitals need them too. And they need to male data available to the public as a way of forcing improvement. That’s a prescription for change from a Johns Hopkins cancer surgeon named Mark Makary, who outlined his ideas in a book published this year called Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care.
“A consumer should be able to look up the percentage of hospitalized patients who are readmitted to a hospital within ninety days, categorized by the discharging diagnosis,” writes Dr. Makary. In the trade, it’s called the bounceback rate and it’s a good starting point to distinguish the good from the bad. Scores can be adjusted for patient disease complexity, overcoming the big reason hospitals like Boston’s Harvard teaching hospitals want little to do with outcome scoring.
“Consumers should also be able to go online and enter their medical condition or proposed operation and review the hospitalwide complication rate for that treatment or procedure.” Data should be available for the major complications encountered in surgery: respiratory, cardiovascular, bleeding, wound/infectious, gastrointestinal/malnutrition, kidney and neurologic. Risk-adjusted mortality data should be available. Dr. Makary found that a very simple survey administered to hospital staff members may provide the most comprehensive and revealing metric available in health care.
He says that the percentage of doctors, nurses and other healthcare workers at a given institution who answer yes to the following questions should be made public:
- Would you have your operation at the hospital in which you work?
- Do you feel comfortable speaking up when you have a safety concern?
- Does the teamwork here promote doing what’s right for the patient?
Bad scores are not the Death Penalty for the institutions involved. Dr. Makary reports several examples where hospitals turned cultures around relatively quickly, and dramatically improved performance, after receiving negative reports. His book is full of examples of mistakes that could have been corrected. And he has a lot of praise for hospitals that he feels have gotten it right. Three he mentions are Mayo Clinic, Cleveland Clinic, and the Geisinger Medical Center in Danville, PA.