The benefit of openness

Wednesday, March 30, 2011 | 2:01 a.m.

Nearly a century ago, a Harvard-trained surgeon created a controversy in the Boston medical community by advocating for hospital transparency. Dr. Ernest Amory Codman, an innovative physician whose work is still referenced today, targeted hospital care. He said hospitals should compile and release information about whether their treatments worked. Codman argued that doctors could learn from patient outcomes, and he was open to admitting mistakes.

Codman was quickly rebuffed and ostracized by many colleagues — the local medical society even asked for his resignation. In the years since, doctors and hospitals across the country have largely stood against releasing data on patient outcomes.

Why?

Some doctors and hospitals say the data can be misunderstood and lead to medical malpractice lawsuits. And they simply don’t want to talk about medical errors and preventable injuries and illnesses because of the blame that comes with it.

But that’s the wrong attitude — it shouldn’t be about blame but providing better medical care. The lack of transparency at hospitals has led to mistakes being repeated, causing patients to suffer from preventable injuries and illnesses.

Nevada has seen that firsthand. The Las Vegas Sun’s “Do No Harm” series, a two-year investigation based on an analysis of hospital billing records submitted to the state, found 3,689 preventable infections and injuries in Las Vegas hospitals in 2008 and 2009. Patients died at the hospitals in 354 cases.

Most states, including Nevada, don’t require hospitals to disclose data on patient outcomes. In Nevada, hospitals have stood against it, although a few have responded to the Sun’s investigation by posting some data. In Carson City, the Legislature has responded to the Sun’s work by introducing legislation mandating the release of information about hospital performance.

It makes sense. Releasing the information would give patients the ability to make informed decisions about where to receive care. It would also force hospitals to focus on improving and reducing preventable injuries and illnesses. Over the past two decades, several hospitals across the country have moved to become more transparent, and they have seen improvements. They haven’t seen an increase in medical malpractice lawsuits — in some cases, lawsuits have decreased.

In the past decade, there has been a major change in hospitals in Boston, the city where Codman stirred controversy. Paul Levy, former CEO of Beth Israel Deaconess Medical Center, a Harvard-affiliated teaching hospital, started blogging about injuries and illnesses suffered by patients at the facility. As Marshall Allen reported in Sunday’s Sun, Levy quickly attracted critics.

But he continued, and the state eventually passed a law requiring transparency. It’s no wonder why. Officials at Beth Israel say making the data public has been a significant factor in the hospital’s performance. Beth Israel has seen reductions in the rate of infection, the amount of time patients stay in intensive care and mortality.

Transparency works — it shouldn’t take a century to catch on. Gov. Brian Sandoval and the Legislature should mandate it in Nevada.