Miller and Daniels acknowledge that physicians and others within the organization were not initially ecstatic that physicians were going to be rated and critiqued on the hospital's own website, or that other quality data would be posted; some thought the new era of candor was ill-advised.
"There are people who think you shouldn't put negative things on a doctor's website," Daniels says. As many as a dozen were "vehemently opposed," Miller says.
But hospital leadership launched a convincing campaign, specifying certain elements the program had to include. One, Miller says, is that the highest levels of hospital and physician leadership had to give support, which they did. Second, "it's essential to have an office that's in charge of managing the information that comes back from the survey." And third, that there would be an appeals process for physicians to make a case that a comment is unfair.
The system is in the process of posting other quality measures on its site as well, such as links to Medicare data posted on Hospital Compare. Key to taking that action, says Brian Gresh, University of Utah's senior director of interactive marketing and Web, is to make a decision and stick to it, and not post measures just when scores are favorable, and dump them when they're not.
"We have said we're not going to cherry-pick the information, and I am adamant about that," Gresh says. "Consumers are smart; they have access to a ton of data, and if we are going to present it on our site we have to be as transparent as possible. Because if we aren't, they can go to another source and find data that contradicts that or puts it into question."
At 649-bed Beth Israel Deaconess Medical Center in Boston, the road to transparency began in 2003, says Chief Quality Officer Kenneth Sands, MD.
Commercial reputation seemed to suggest BIDMC's competitors were better hospitals, "but when we looked at the data, it didn't look that way to us; it looked like we were the same or better. So we felt there was nothing to lose by creating a more level playing field, by making the data available."
Not only are links to dozens of patient quality and safety measures posted on the hospital's home page, Beth Israel also links to The Joint Commission's survey report.
"We wrote down criteria that would qualify to be shared publicly," Sands says. The data "has to be relevant to patient decision-making, reliable, reproducible, understandable, and valid. And we have a 'no cherry-picking' rule, too."
Some physicians were eager to have more data posted, measures that are relevant to a small subspecialty, for example. Those would meet the criteria, Sands says.
BIDMC also focuses on harm prevention, including a list of patient harm incidents by quarter, where the organization has had problems, and with specifics, what it is doing to improve.