Second thoughts on transparency in Ontario and Denmark

Barb Farlow, a patient advocate in Ontario, mentions a debate going on in that province. Here is an excerpt from a legal blog called Legal Feeds:

Governments often slip little-noticed and seemingly unrelated items into their spending plans, but just a single line in the recent provincial budget measures bill is causing a split within Ontario’s medical community.

Section 15 of the “better tomorrow for Ontario act,” which is currently in second reading before the legislature, would amend the Freedom of Information and Protection of Privacy Act to provide an exemption for the release of “information provided to, or records prepared by, a hospital committee for the purpose of assessing or evaluating the quality of health care and directly related programs and services provided by the hospital.”

The provisions take effect Jan. 1, 2012. The new amendments come just a few months after the government passed Bill 122, the Broader Public Sector Accountability Act, that provided broad public access to hospitals’ administrative and policy-related information for the first time by subjecting them to the freedom of information act. The latest proposed changes would partially reverse those reforms.

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.

I noticed a similar attitude among colleagues attending the recent conference in Copenhagen, summarized in an article by Anders Heissel in Dagens Medicin. After I gave my talk about our hospital's decision to disclose infection rates and medical errors broadly to help stimulate process improvement, some had these reactions:

Apparently 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.

The Director of the country's largest hospital, Odense University Hospital, Jane Kraglund, believes that the hospitals already publish enough data about quality.

"Our quality is transparent, but we do not learn much by putting a malpractice on the website. When we make mistakes, we have a strict system where the error is systematically reviewed, but it will not necessarily come out to the public. Moreover, more information about risk would be more confusing for the patient, "says Jane Kraglund.

Steen Mikkelsen, Director of Hospital North (hospitals in Roskilde, Køge, Holbæk, Kalundborg and Fakse), said,

"We are constantly in a competitive situation, and our standing could be damaged if there are too many bad stories about a place where you expect to get the best treatment. Clearly we will inform patients about possible errors, but the question is whether we should only do it to the patient or to the whole public. I am in doubt as to whether he mistakes we make always give rise to learning."

Proving I guess, that the survey I did that day in Denmark may not have been quite honest or accurate!

Proving also that a fundamental problem is that doctors do not believe the public will accurately or fairly judge hospitals that are honest about such matters. We never found that to be a problem at out hospital, and we were as transparent about such things as you can imagine. Our market share actually grew following our decision to be open about our clinical results, as clinical partners who agreed with our philosophy referred patients to us.

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.