My organization, New York City Health and Hospitals Corp.the largest public hospital system in the U.S.last month voluntarily released safety and quality data, including our individual facility mortality and hospital-acquired infection rates.
Although transparency is most often talked about in terms of better-informed decisionmaking by patients, the usefulness of most publicly available data for that purpose is questionable. Process data, such as the current CMS quality measures that reflect adherence to certain evidence-based practices, can inform meaningful comparison across providers and facilities. If the evidence shows that an aspirin and beta blocker on admission tend to improve outcomes for heart attack victims, then more consistency in administering these medications should equate with better care.
However, outcome data, which include mortality rates, can be more vexing. Differences among patient populationsincluding average age, the prevalence of comorbidities and socio-economic statuscan account for apparent differences in mortality rates. Our ability to normalize mortality data reliably across different patient populations remains dubious. On the other hand, some outcome measures, such as the incidence of hospital-acquired infections or decubitus ulcers, lend themselves more readily to reasonably fair comparison across facilities.
Given these complexities and caveats, what benefits can we actually expect from greater transparency? Would access to more meaningful comparative data really help patients make more informed healthcare choices? After all, many factors already constrain a patients choice of hospital, including proximity, doctors admitting privileges and health insurance. And in a true emergency, a patient may have no choice whatsoever; proximity may trump all other factors.
We released our data to accomplish two objectives: to further focus and accelerate our own performance improvements and to engender greater trust in the communities we serve by demonstrating our commitment to render the best possible care. I believe that over time the data we share will help patients (and community physicians, who strongly influence choice of hospitals) to better assess our overall quality of care. (The data are available at nyc.gov.)
Our systemwide and facility-specific mortality rates are a bottom-line indicator of our success in reducing preventable deaths through the deployment of a wide variety of initiatives ranging from rapid response teams to meticulous medication reconciliation. There is value and purpose to having all staff focused on that bottom-line indicator. We cannot identify the specific patients who might have died from ventilator-associated pneumonia in our intensive-care units if we had not reduced our systemwide infection rate by nearly 70% in the past year. But these efforts and others, if properly implemented, should prevent needless deaths and lower our overall annual mortality rate.
Similarly, because hospital-acquired infections are such a threat to patients (with the federal government estimating they cause more than 90,000 deaths annually), we are placing a heavy emphasis on implementing the clinical practices that reduce the risk of such infections. So we have decided to begin sharing that specific data publicly as well.
Performance improvement starts with honestly confronting brutal realities of less-than-perfect performance and then mobilizing everyone in the organization toward concrete improvement objectives that matter the most for our patients. Transparency for us is about openly sharing our current reality on important quality and patient-safety measures with our entire organization, measuring whether our efforts are changing that reality in the positive ways we seek, and letting our patients and community look over our shoulders in the process.
Of course, broad transparency within a hospital or a hospital system effectively means that the information that you are sharingespecially sensitive information about patient safetywill likely slip beyond the hospitals walls to the broader community. As a result, if you do not share the data willingly and purposefully with the community, it will find its way there anyway. And, yes, it does raise the stakes if your patients and community can monitor whether you are moving your performance in the right direction. We believe that is a risk well worth taking and that our patients and community have a right to judge us on whether our data reflect that patient safety is truly the organizational priority we say it is.
Indeed, early last year, we made a public commitment to our patients and community that we would make patient safety one of our organizations highest priorities and that we would become one of the safest hospital systems in the nation by the end of this decade. There are many specific patient-safety initiatives that are contributing to safer patient care in our system. But hardwiring a hospital system for maximum safety requires a fundamental transformation of an organizations culture in order to focus relentlessly on preventable patient harm.
We need all of our systems stafffrom trauma surgeons to housekeepersto be vigilant and to take ownership of our patients safety. We need all staff to point out the risks and near-misses that they see every day, and to apply their experience and common sense to the redesign of our processes of care that can keep our patients safe.
By issuing data publicly, we empower our staff to actively and openly communicate about imperfections in our processes of care. We ask our leadership to commit to fix the vulnerable places in the process where patients may be harmed. We encourage our facilities to build a culture of safety that steps forward toward improvement nimbly and responsibly. And we invite the communities we serve to employ the data we are posting to assess our work, our progress and our commitment to their health.