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.