Hospitals Argue That More Transparency On Medical Errors Will Decrease Dialogue On Fixing Them
from the uh,-what? dept
Tim O’Reilly points us to a bizarre story about how some hospital and medical officials in both Canada and Denmark are fighting against efforts to make data on medical errors more open to the public because it might “decrease frank and open dialogue” about how to correct those errors.
Huh?
This makes absolutely no sense, and seems to be one of those things that people say when they have no good excuse for stifling the free flow of information, but figure that if they just answer the question with complete nonsense, maybe it’ll take time for people to realize it’s nonsense, and everyone can move on:
Health Minister Deb Matthews has defended the move to exempt information related to quality of care from public release. According to the Free Press, Matthews believes subjecting hospitals and doctors to greater scrutiny would prevent open dialogue about problems and how to fix them. ?They must have a very open and frank discussion,? she said.
Of course, there are situations in which you could see certain types of information being revealed might hold back open discussion… but how is that true here? If anything, it seems likely that the reverse would be happening here. Keeping this kind of data private is how you avoid having to have those “frank and open dialogues” about fixing the problems. It’s how you sweep the problems under the rug and pretend they don’t exist.
As the author of the linked blog post, Paul Levy, notes:
It is time for health care professionals to understand that patients can be trusted to be active partners in process improvement. Disclosure of clinical outcomes is a first and necessary step along that path.
Filed Under: healthcare, hospitals, medical data, transparency
Comments on “Hospitals Argue That More Transparency On Medical Errors Will Decrease Dialogue On Fixing Them”
Bureaucratic Mindset
If we tell the public, they’ll find out we’re not omniscient gods.
It’s also possible they fear the American Disease: lawsuits.
Re: Bureaucratic Mindset
seems more likely than most other explainations.
Obviously
Sometimes you just have to pay more to be slower… it makes sense if you don’t think about it.
Wait, wrong meme….
Allowing open and honest discussion would prevent open and honest discussion… it makes sense if you don’t think about it.
Bureaucratic Love of Secrecy
What we have here is plain ordinary common-or-garden bureaucratic love of secrecy. The solution is to sack the bureaucrats concerned. No warnings are required. They know exactly what they are doing and they have decided to do it anyway. It is the equivalent of pulling down their pants and farting in the direction of the government.
The fact that the health minister has bought into it, means that she is part of the problem, not part of the solution. She has to go too. Once all the sackings have happened, future secrecy-loving bureaucrats will have to be a lot more circumspect. Cabinet should be particularly careful to sack the actual perps, not any offered sacrificial goats.
Okay, I’m in partial agreement with them here, so I’ll explain why I agree with them.
I’m going to argue by example, just to show there’s something beyond potentially meaningless rhetoric.
Take MS. I know our local MS society rep pretty well, he’s a cool guy. How many of you know about the zamboni treatment? Basically, they open up the veins/arteries whatever to your brain, and at least in the short term, we’ve seen some miraculous recovery in MS patients.
It’s still highly experimental. It might be a temporary cure, it might kill patients sharply after some years, it might initially be better but then make the patient much worse.
What do you think awareness of this treatment has done in Canada surrounding discussion of MS treatment? Yeah, it’s gone down the tubes.
The doctors want to give the treatment a 5-year testing period, ‘the public’ wants to make the treatment immediately available.
Some people are outright outraged that they can’t get the treatment here, for any price, but that if they have some 25k, (which they don’t, because they need 20k a year for MS medicine), they could go to europe and get the system, and some idiotic arguments exist about how this creates a two-tiered system.
A conference which discusses MS treatments, mostly between doctors, some politicians and MS society reps, has not happened because there is too much internal argument in the doctor and MS society groups over what their stance should be. Which means that widespread acceptance of a cheaper drug that hit the market earlier this year, (10k per year treatment, may cause some relatively minor side-effect, (diarrhea, maybe?), otherwise clinical trials rate it about the same as existing medicine, well anyway, it hasn’t received the acceptance it normally would.
tl;dr: I’m afraid it will cause a situation where the media circus can begin to run medicine as the public/patients all begin to demand ‘miracle’ cures that may or may not be cures, and may and may not be dangerous. We certainly see this happen a lot already. The specific part I’m concerned with is experimental drugs/treatments being forced to be released too soon, or over-developed to the detriment of other experimental drugs/treatments which may work better, or even just work while the ‘miracle cure’ doesn’t.
Re: Re:
I can understand this point of view. Basically, when the “uneducated mob” gets involved, things can get ugly… To keep things flowing positively, they need to maintain a level of rationality around these discussions, and as we all know, there are many people out there who have no idea what the word rational means, or at least are good at pretending they don’t.
I think though, that if we’re talking about errors and how to correct them, the logic above doesn’t apply. I would accept that for research and new treatments, you don’t want to have people talking themselves into a false sense of security, especially when they don’t know everything they should. Errors are things that have happened already, and solutions can come from anywhere. Personally, I think the stuff is so boring that most of the public won’t care to get involved. If that’s the case, it’ll only draw interested and invested people into the discussion, and I believe that would be very good for progress. Mention a cure for cancer though, and all the crazies would come out of hiding…
Re: Re:
I see your point about the media circus that would surround this, but we already have a circus going on. I just saw an ad on TV about Ambien. According to the ad, it MAY control my asthma. Downside, higher rate of death from the condition it’s supposed to relieve. Researchers and the Government Agencies are pretty good at ignoring outside comments already, so I don’t see how hiding knowledge from some people who can actually think would be a good thing.
Oil Companies Argue That More Transparency On Oil Spills Will Decrease Dialogue On Fixing Them
It's not really this complicated.
No one likes to be embarrassed. Given a choice between public humiliation or status quo, it would take a great deal of integrity to choose humiliation. Character and integrity are not really prevalent.
-C
If a doctor I was seeing believed that “subjecting hospitals and doctors to greater scrutiny would prevent open dialogue about problems and how to fix them because “they must have a very open and frank discussion?, I would seriously doubt his/her critical thinking abilities. If they really believed that hiding or obscuring relevant information/data is beneficial, in any way, I would not trust them to be able to diagnose anything.
Re: The Real Issue
“most of the Danish hospital managers who were present felt that one should be cautious in opening the door to more information that exposes the hospital’s deficiencies.”
I translate this as “I know we suck, just don’t tell anyone. How do you expect us to make any money if you let people know how many people we infected/killed/performed the wrong procedure on?
I am certain that doctors and hospitals would share such data if it could not be used against them in future litigation. This proposal is a plaintiff lawyer’s dream. Small wonder they are reluctant to embrace it with open arms.
About 20 years ago federal contractors were encouraged to share information with the government in matters of potential mischarging under government contracts. Note my use of the word “potential”, because it is a rare circumstance where a major federal contractor actually has someone in its employ who engages in such misdeeds. Of course, the all too predictable result has been that virtually every instance of disclosure to the government results in the filing of charges, the vast majority of which are without merit, and then demanding a large sum in order to settle the matter. Contractors almost invariably settle just to make the matter go away, and then are left to deal with headlines reporting the settlements and leading the readers to beleive that the charges were meritorious, when in fact they were not.
There is Utopia, and there is cold, hard reality. As much as I wish Utopia ruled the day, quite unfortunately it does not.
I am certain that doctors and hospitals would share such data if it could not be used against them in future litigation. This proposal is a plaintiff lawyer’s dream. Small wonder they are reluctant to embrace it with open arms.
About 20 years ago federal contractors were encouraged to share information with the government in matters of potential mischarging under government contracts. Note my use of the word “potential”, because it is a rare circumstance where a major federal contractor actually has someone in its employ who engages in such misdeeds. Of course, the all too predictable result has been that virtually every instance of disclosure to the government results in the filing of charges, the vast majority of which are without merit, and then demanding a large sum in order to settle the matter. Contractors almost invariably settle just to make the matter go away, and then are left to deal with headlines reporting the settlements and leading the readers to beleive that the charges were meritorious, when in fact they were not.
There is Utopia, and there is cold, hard reality. As much as I wish Utopia ruled the day, quite unfortunately it does not.
Re: Re:
So basically, don’t hate the player, hate the game?
Re: Re: Re:
A fair point. The potential of liability for significant monetary awards is not a situation likely to encourage the free flow of information, no matter how beneficial that information would be.
To add your words to mine, there is Utopia, and there there is how the game is really played.
I am certain that doctors and hospitals would share such data if it could not be used against them in future litigation. This proposal is a plaintiff lawyer’s dream. Small wonder they are reluctant to embrace it with open arms.
About 20 years ago federal contractors were encouraged to share information with the government in matters of potential mischarging under government contracts. Note my use of the word “potential”, because it is a rare circumstance where a major federal contractor actually has someone in its employ who engages in such misdeeds. Of course, the all too predictable result has been that virtually every instance of disclosure to the government results in the filing of charges, the vast majority of which are without merit, and then demanding a large sum in order to settle the matter. Contractors almost invariably settle just to make the matter go away, and then are left to deal with headlines reporting the settlements and leading the readers to beleive that the charges were meritorious, when in fact they were not.
There is Utopia, and there is cold, hard reality. As much as I wish Utopia ruled the day, quite unfortunately it does not.
What happened that resulted in multiple posts of this comment escape me. Hit submit and this is what resulted.
Sorry…
Let us sweep it under the rug and we promise we’ll fix it.
No, really we will. Not kidding. I can’t understand why you would think any differently. Stop being so difficult. We are here for you. You, you, you, God you!
Kettle calling the pot black
I’m requesting of Floor64 a bulleted list each deficiency within the organization. This will foster a great discussion about how we can help you run your company better that you can.
Re: Kettle calling the pot black
I think you have your proverbs wrong. IT’s time a boot posterior and chew rubber-based materials, alas, one is all out of said material…
Hell in health Denmark
As a Danish resident, I can bear witness to the hell people have to go through when trying to get proper information from their medical records, not to mention getting redress or having someone assume responsibility when mistakes are committed. It’s like trying to “hit a down comforter”, as the very Danish expression goes.
The answer comes from the Pilots
The FAA has for decades has sponsored a very effective error reporting system among pilots, controllers, etc. If the pilot, controller etc is part of or witnesses an operational error, the pilot, controller can report the circumstances and proposed solution within 10 days to … NASA. NASA returns a confirmation of receipt to the pilot, who thereafter cannot be disciplined by the FAA for fault in the incident (if there is any – you just show up to the hearing and waive the NASA form around). NASA accumulates the data for the FAA anonymously and reports its findings of trends in errors to the FAA. NASA is used to manage the data because no sane pilot or controller would trust the FAA. NASA, having no regulatory authority in the area, has no dog in the hunt. NASA’s anonymous data is public.
The system has been extremely successful in spotting important and common errors and fixing them. The incentive is its anonymity combined with its get out of jail free card. The running joke is at the end of every commercial flight, the last item on the post shutdown checklist is “FILE ASRS FORM) – the name of the reporting form. The pilots sit there and think of every little thing that went wrong and send in the forms.
You can be sure that right after that Air France A380 clipped the Delta CJR at Kennedy a few days ago, a veritable snow storm of forms arrived at NASA.
There are limits – if you crash the plane, kill people, kill yourself, destroy multi-million dollar aircraft, you don’t get out of jail free simply by filing an ASRS form, but on the other hand, you probably have much bigger personal problems (death, for example) anyway.
Also, there is an annual limit on how many times a year you can get out of jail (not how many forms you file, but how many times you can block discipline by filing the forms). But that limit doesn’t destroy the incentive to file the forms, because most operational errors are not formally detected or pursued by the FAA in any case (to small to bother with). So you file like mad and hope for the best.
If medicine had a system with similar incentives, the flood of error reporting would be amazing. Picture some error in the operating room. Every single person in there, not just the doc who screwed up, but every other person, the other docs, the nurses, etc. would all be scrambling to get their get out of jail free cards filed. Proposed solutions, many of which in the case of NASA have been adopted by the FAA, etc.
The medical version could include immunity from lawsuits combined with some compensation fund for the patient, up to some limit (you might exclude actually killing the patient).
You would need a whole new bureaucracy to handle the snowstorm of error forms.
Transparency will be the single most important tool to move the bar on the quality of health care in America. Without it, we will continue to remain way down on the list of outcomes.
Why? Because we have no other checks and balance system in place. Providers and facility administrators are the only gatekeepers. Patients, who pay exhorbitant prices for the care they receive need to be handed the gatekeeper role by being able to choose a facility based on quality outcome data. Choosing a hospital can and often is a life-or-death decision.
Health care facility leaders and boards have had well over ten years to improve. If they haven’t made valiant efforts to invest in patient safety, then they deserve to have their poor quality outcome data exposed. It is truly the missing piece in health care that drives costs up and quality down.
As they saying goes “Give us our damn data”…..”Please”.
In contrast
The University of Michigan Health System has a long standing policy of actively looking for medical errors, informing the patient, apologizing (how quaint!), and offering compensation. Patients who accept compensation are not required to sign away their right to sue later.
They claim this has improved patient safety, while admitting this is difficult to measure. What it has absolutely done is DECREASE legal costs by 61% since implementation in 2001.
…story
Hospitals Argue That More Transparency On Medical Errors Will Decrease Dialogue On Fixing Them
A step into the future: Sunnybrook hospital in Toronto offers MyChart – has anyone here seen something like this ?
Medical records at the click of a mouse – Healthzone.ca
http://www.healthzone.ca
http://www.healthzone.ca/health/newsfeatures/article/926713–medical-records-at-the-click-of-a-mouse
Just as they go online to pay bills, renew library books and buy movie tickets, patients at Sunnybrook Health Sciences Centre can now log on the…
More transparency = more off the books
The more you increase public liability for medical errors, the more medical errors will no longer be reported. I am in medical school. It can be quite easy to hide your mistakes if you choose to, just like in any job. If you increase pressures on doctors to be publicly shamed for errors, they will still make mistakes. They just won’t report them.
If at your job you see a good employee gets fired after going to his boss and reporting that they had screwed up, they made an error, how likely would you be to walk into your bosses office and report an error?
It doesn’t take a rocket scientist to figure out that most would try to cover up their error. Does that help the company? Of course not.
Healthcare is the same way. The errors we see or that get reported are just the obvious cases, like infusing the wrong blood type (although those have been covered up also because you usually die) or operating on the wrong knee (those are pretty obvious and you usually don’t die.
It doesn’t improve healthcare, that is for sure. Do we want to go to a healthcare system where there is open communication but no liability? My mother entered a Tricare (military) hospital (brand new) for one thing but died because of an infection she picked up in the hospital. You can’t sue a Tricare facility.
Will we accept that?
Not so sure about this one...
Time and again, my wife (a doctor) tells me of intelligent (and even well educated) people taking information gleaned from some random medical web site and then draw incorrect conclusions because they don’t have the requisite medical background to understand the complete context.
As a result, I’m fairly certain she’d fight to keep discussions about patients just among doctors for exactly that reason. For many cases, yes, transparency forces better more informed discussions, but in this case, since the medical profession is a highly complicated one, I can’t see that transparency would lead to a qualitatively better result for patients. Quite the opposite, I could see patients not fully understanding the total context of the total choices and making a poorer judgement overall.
But try telling that to Americans who have an acute and culturally-founded distrust of their government and/or any authority. I get that “we know what’s good for you” is the seed of abuse, but the medical profession doesn’t typically breed power-hungry politicians tempted to misuse their power and destroy the lives of the people they are sworn to heal.
Our Canadian secrets
Thank you very much for writing about our predicament in Ontario, Canada, where our government is being influenced to put insurance and hospital lobbyist interests over the public interest.
A culture of secrecy does not build a culture of trust.
We have a public healthcare system in Canada and that is a point of patriotic pride for many up here. But how public is a healthcare system that hides its quality information from citizens?
We appreciate your support in accessing hospital information in the spirit of transparency and accountability.
The hospital secrecy law (Bill 173 s.15) is an orphan amendment in the province’s (like state) budget bill. Ontario is Canada’s biggest province, analogous to NY State and Washington DC combined, in terms of power structure.
This amendment will take away our right to access hospital quality information.
The amendment was proposed by our hospital association and malpractice insurance companies and our Health Minister says they “persuaded” her to resurrect this previously defeated amendment and stick it back in the budget bill.
We have a growing public opposition to this hospital secrecy law, by health groups, patient advocates, nurses, unions, church groups, lawyers and citizens.
But we need more media coverage. Please spread the word. And for more information, friend us at “Every Patient Matters” on Facebook.
The vote on the hospital secrecy law is May 5. Nine committee members will be deciding whether to revoke the freedom of information rights of 13+ million Canadians.