What does the future of healthcare transparency look like?
It is clear that across the world’s health systems — both high and middle income — there is a steady rise in calls for transparency and implementation of new policies to promote it. To some this represents a growing encroachment into professional autonomy that at best distracts from the real work of caring for patients and at worst creates a fear-based culture of public exposure and blame. It is easy to imagine a dystopian future if this kind of transparency is left to run unchecked — with systems awash with meaningless or actively misleading data, providers averse to any risks that might lead to their being named-and- shamed and an increase in top-down micro-management of frontline delivery.
This is not the future we foresee, however. Increasing understanding of the risks and benefits of transparency should give cause for cautious optimism about its use in health systems of the future. There is no doubt that the trends towards greater transparency will continue — the explosion in the amount of healthcare data and rising consumer expectations of patients and the public make that almost inevitable. For those providers and payers that are prepared, the opportunities will outweigh the threats. The following is our considered prediction of the world we can reasonably expect to see develop over the next five years, with case studies interspersed of where this is happening already.
Less name and shame
While some of the movement to publish more healthcare data has been ideologically led, and often associated with rooting out poor performance, the limitations of this approach are becoming more apparent. Resistance among providers — much of it justifiable — and the lack of supportive evidence for ‘name and shame’ strategies is forcing health systems to tip the balance in favour of partnership, not penalty. Transparency will come to be seen more as a strategic enabler of smarter decision making: whether it be government policy and investment decisions; civic organizations judging the fairness of the allocation process; purchasers deciding which services to commission or providers designing care pathways. Since the most significant improvements resulting from transparency have come through peer-to-peer learning and review, this is something that is likely to be seen as a more common first stage in future (exemplified by global movements such as ICHOM). Clinicians have proved far more willing to share performance information within their own clinical communities at first than straight to public reporting. It is felt this approach creates a safer, non judgemental environment on which to focus on improvement. They will also tolerate less robust data when using it for internal quality improvement.
At Helios, a 112-hospital group in Germany, they have used peer review for over 10 years to guide clinician-led improvements. Quality indicators, derived from routine data and referenced against the averages from all German hospitals, are publically reported for each hospital in the group. Whenever an indicator shows below-average outcomes for a Helios hospital, the peer review process is initiated: clinician colleagues from other Helios hospitals analyse the medical records of deceased patients treated in the hospital concerned and provide improvement suggestions in detailed protocols. Evidence indicates this peer review process has had significant impact on mortality rates for a range of conditions, with 710 ‘saved lives’ over the study period 2004–2011.
We have published a Global Health Systems Transparency Index that showcases data from country-to-country, according to our study. Please get more details here
Through the Looking glass: A practical Path to Improving Healthcare Through Transparency