NEW EVIDENCE THAT "TRANSPARENCY" OF ERRORS CAUSES PATIENTS TO AVOID NECESSARY MEDICAL CARE OR TO ABSTAIN FROM PARTICIPATING IN RESEARCH STUDIES AND REDUCES HEALTHCARE PROVIDER MORALE 
Author Peggy Binzer  | July 28, 2017
More than a year after NIH published a study based on a medical error that damaged the hospital's reputation, NIH continues to suffer from patients abstaining from care or participating in research studies and languishing healthcare provider morale.  An April 2016 report commissioned by Dr. Collins concluded that the NIH doctors had allowed patient safety to be subservient to research.  This contention has been strongly disputed by NIH Physicians.  The report was triggered in 2015 when fungus was found in two medicine vials at the hospitals pharmacy.  According to the NIH Clinical Center, the number of research patients who come into the hospital for chemotherapy and other treatment has fallen to 7,836 patient visits/month in June to 9,601 in March (about a 30% drop in outpatients).  The number of hospitalized research patients has also significantly dropped.  The lower patient census results in less research overall and potentially fewer groundbreaking scientific findings.  In addition to the consensus data, the current report is based on interviews of over 600 NIH participants between July 2016 and May.  The report concluded that the initial report has a profound, negative impact on staff morale.   
AQIPS members have reported symptoms of patients losing confidence in the healthcare system - the NIH census report is part of the growing body of evidence of patients refusing care because of the publicity of a medical error. Transparency is an "accountability" program defined as the monitoring of a healthcare provider to prevent them from making bad decisions that could result in a medical error that could otherwise be prevented.  This hypothesis is rooted in the falsity that healthcare providers are the direct cause of all patient harm resulting from medical errors.  There is wide acceptance by patient safety experts that faulty systems not poor performance is the cause of most preventable harm in healthcare.  This is also why providers cannot "get to zero" for most patient harm through transparency, because transparency does not take systems errors into account. It is no surprise that there is mounting evidence that transparency does not result in improved performance by providers or hospitals. The areas that healthcare facilities have been able to get to zero are areas focused on human behavior, such as hand washing.  Most patient safety events are complicated systems errors, such as surgical or medication errors, which cannot be reduced simply by monitoring the healthcare providers behavior as new technologies and processes are introducing the risk of errors caused by the system and process.   There have been no scientific studies on whether transparency is effective in preventing harm and the mounting evidence indicates that transparency of medical errors does not improve provider performance, diminishes provider morale and results in damaging consequences to patients. Transparency needs to be clearly defined and its proper place needs to be studied in healthcare to avoid unintended consequences to the patients responding to the information.  Physicians and other healthcare providers who participate in quality improvement programs designed to improve the reliability of certain procedures protected by the Patient Safety Act protections state that they are better doctors because of their participation and patient outcomes improve.  
 

 

Confidential Transparency of Incidents Among Providers is Beneficial to Patients: but too much transparency can be harmful to patients’ health.

Author Peggy Binzer  | January 4, 2016

Too much of a good thing often leads to a bad result.

Think of consuming candy – candy can make us feel good but consuming too much can lead to a tummy ache in the short term and obesity and its related sequelae in the long term. Transparency of medical errors to patients by their healthcare providers is a postive interaction. The Patient Safety Act does not prohibit disclosure of medical errors to patients by their health care providers. To the contrary, the Patient Safety Act encourages transparency among health care providers under the protection of the privilege for patient safety work product (PSWP) so that lives can be saved by sharing critical information to insure that medical errors are not repeated to harm other patients in other hospitals and health care entities across the health care continuum. 42 C.F.R. 3.206(b)(4)(iv)(A).  

However, transparency of incident reports is deceiving to consumers as high reliability systems – those health care providers who foster a strong safety and learning culture and who encourage incident reporting will have more events to analyze and evaluate to achieve consistent quality – than hospitals that are not reporting to a Patient Safety Organization (PSO). Hospitals with a weaker safety culture will have a lower number of events not because events are not occurring, but because these incidents are not being reported. As a result, health care consumers in our data-driven culture may mistakenly be led to believe that the high performing hospitals that invest heavily in safe systems and safety culture provide lower quality and value of care – which then punishes the high performing providers and correspondingly punishes patients. Incident reports are not an indicator of quality or value and simply cannot be used for consumers to make a decision on the quality or value of health care. Indeed, the more incident reports that are collected, the more learning can be accomplished and a higher quality of care can be achieved.  

The Patient Safety Act supports protected transparency among providers and the sharing of best practices throughout the entire healthcare continuum – which leads to improved care to the benefit of patients. This benefit to patients will not occur without confidentiality and privilege protections for the information. 

Transparency of evidence-based quality measures can provide information to consumers to make an informed healthcare quality/value health care decision.  Further, the Patient Safety Act grants providers tools to improve quality measures and improve the quality of health care through reporting and analysis in their Patient Safety Evaluation System. Congress carefully constructed the Patient Safety Act to balance the need for providers to have confidentiality protections for self-critical analysis, and the need for accountability. Importantly, the Patient Safety Act privilege does not keep information from regulators or patients and does not hide healthcare providers who consistently provide substandard care – this information is in original records such as medical and billing records, which are not covered under the Patient Safety Act. The Patient Safety Act is designed to provide a nationally uniform privilege for reports and conversations in a Patient Safety Evaluation System to allow providers to learn from mistakes and other quality information to improve patient safety, patient outcomes and the quality of patient care.