The Great Disclosure Debate

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Reporting quality scores on certain core measures is common practice for hospitals, but senior leaders across the country are encountering mounting pressure from board members, regulators, competitors and customers to take their data reporting a step further: full transparency. Hospital leaders and quality departments meet regularly to debate the whys and why nots of such disclosure, but few have pulled the trigger. With a small but growing number of hospitals opting to report quality data on their own Web sites, however, that could be changing.

Devil’s in the debate

For hospitals still entrenched in the transparency decision process, the list of “why nots” is a long one: It will take too many resources. We already have more reports than we can handle. Consumers won’t understand the data. The public relations and legal risks are too high. Senior leaders at Sinai Hospital of Baltimore, for instance, spent more than a year debating before deciding they weren’t yet ready to post quality scores on their Web site. “The more we discussed, the more we talked ourselves out of it,” says Sinai Vice President Barbara Epke.

But transparency is a no-brainer for the handful of hospitals that have passed the debate stages and launched their own quality Web sites. Executives at such organizations argue that, when done right, a hospital-driven public reporting tool will actually improve customer understanding, reduce the redundancy of reports, and improve the efficiency of the quality department.

“Implementing a transparency initiative is easier than it’s ever been. It’s puling to me as to why people haven’t gotten on the bandwagon,” says Daniel Varga, MD, chief medical officer at 20-hospital SSM Healthcare-St. Louis. SSM’s Web site provides data on patient safety, core measures and hospital-acquired infections for its St. Louis-area hospitals, but SSM plans a more extensive quality site by the end of this year.

So why does one system choose to take the quality leap while others do not?

Board buy-in

In March 2005, Louisville, KY-based Norton Healthcare launched the Norton Quality Report, a section of the system’s Web site that lists Norton’s scores on more than 400 quality indicators. Norton’s transparency push was driven by the board’s belief in accountability. With the board’s backing—and insistence—Norton’s quality stakeholders were free to focus their energies on delivery rather than debate.

That’s when the real talking began. Norton’s quality leaders educated the board and all internal audiences on what was happening and why. They invited local agencies outside of the hospital, including the local media, to be involved in the transparency process.

“We asked the press to be involved with us in the communication and education process, and we went through painstaking efforts for them to understand how the site actually works,” says Russell Cox, chief operating officer.

To publish or not to publish

The biggest hurdle to full transparency for some hospitals, however, may be the question of which indicators to publish in the first place. This debate is what ultimately halted discussions at Sinai; senior leaders didn’t want to post too few indicators, but they also feared that posting too many would overwhelm consumers.

Norton simplified the “what indicators matter” decision by creating a board-approved policy that says they will report any nationally recognized indicator. Nobody debates, nobody votes—it is policy. Norton’s “all in” approach to transparency remains atypical, however. Most hospitals, like SSM, opt to begin with basic data—core measures, Press Ganey scores, infection rates. Some only choose to publish measures that are reported already on other sites. But even that is a good start, experts say.

“If we wait until we have the holy grail of indicators, we’ll still be waiting two decades from now,” says Varga, who formerly was chief medical officer at Norton.

Perhaps more important than what indicators a hospital actually posts is the explanation behind those indicators. Consumers don’t always understand if a score should be high or low for a particular measure, Cox says, so it’s important to provide clear and coherent explanations throughout the report.

Linked in

Many hospitals not yet ready to publish their own quality scores—and hospitals still entrenched in the debate—use plan B: Partner or link with an outside reporting organization.

“There are so many reporting requirements that hospitals have, it’s all they can do to keep up with these requirements,” says Beverly Miller, senior vice president for professional activities at the Maryland Hospital Association. Maryland is one of several states that have made reporting quality data a requirement for its hospitals; the data is posted through the Maryland Health Care Commission’s Hospital Guide Web site. Area hospitals that don’t host their own reporting site can link to the Maryland site instead.

Sites that are developed through a state partnership or links to other sites provide consumers with a comparative analysis of systems in the region. “The advantage to posting your own data is that you get to tell your own story, but it’s all your own story,” says Alice Gosfield, a Philadelphia-based attorney and consultant who specializes in quality improvement.

Change is good

Regardless of how or when a health system chooses to go public with its data, senior leaders must be ready to make changes to improve outcomes. Clinicians want to be in the normal limits, Varga says, so if areas of the quality report are in the red, the hospital had better be committed to making them green or risk losing clinician support.

“The whole point of this undertaking is to speak to the quality of care provided in your organization,” says Gosfield. “If you don’t have the will to very explicitly improve the quality of care and then continue to keep raising the bar, you’re having the conversation in the wrong place.”

Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at

Simplifying Transparency

Set a date. Hospitals should set a firm date by which they will publish their data. If you wait, you can let resistance build up to such a point that you’ll never get through the process, says Russell Cox of Norton Healthcare.

Keep it simple. When deciding what indicators to publish, don’t invent anything, says Daniel Varga of SSM Healthcare-St. Louis. Use indicators that have already been recognized and endorsed. Varga recommends using Centers for Medicare & Medicaid Services and Joint Commission core measures, as well as National Quality Forum and Agency for Healthcare Research and Quality measures, for a quick start.

Ensure data integrity. Spend some time making sure you have valid data, and that your reporting is right. “If you go out and report indicators badly, it will take you years to regain credibility,” Varga says.




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