Despite significant efforts by numerous organizations, medical error still exists in the laboratory and hospitals in general. In Tuesday’s plenary session, Martin Makary, MD, professor of surgery and health policy at Johns Hopkins University, described how increasing transparency in hospitals can significantly reduce medical error. “There is an incredible movement towards transparency in America today, emphasizing civility, teamwork, and evidence-based practice.”
Makary, who is also author of the best-selling book, Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, named two major barriers to revolutionizing healthcare: access to data and variability in practice. He believes that these are man-made barriers and points to transparency as the answer. For example, a 2013 study determined that there are about 210,000 unintentional hospital deaths in the U.S. per year. Yet, these are not listed among the leading causes of death by CDC. He estimates that it is the third leading cause of death in America and suggests that we need to change the way we collect and publish vital statistics.
Further, despite billions of dollars spent to identify the latest diagnostic and treatment tools, we rarely track patient outcomes once these tools are implemented, Makary noted. Either the data does not exist or the public does not have access to it. Among over 150 government-funded registries tracking patient outcomes in the US, only 3% is available to the public. The goal of Makary’s research is to develop simple ways to make this critical information accessible to the public, ultimately increasing transparency in healthcare.
When he began writing his book, Unaccountable more than 3 years ago, transparency in healthcare was a controversial topic. But the climate around this issue has started to change, he said. Transparency is no longer a dirty word. In fact, there are now numerous examples demonstrating that it works, noted Makary. “Healthcare is on the brink of a revolution,” and transparency is a major reason for this change, he said.
Makary and colleagues have looked at the effects of numerous tools aimed at increasing transparency and reducing medical error, including publishing patient and healthcare worker satisfaction surveys, checklists, and public reporting of medical quality indicators. He cited the examples at the Cleveland Clinic and the University of Utah where patient satisfaction surveys were made available to the public. Making this data available resulted in steadily improved satisfaction ratings along with increased physician rankings.
Using examples from history and art, Makary described how a culture is made. He gave the example of Thomas Eakins’s painting The Gross Clinic, a demonstration of the brutality of healthcare in juxtaposition to Eakin’s 1889 work The Agnew Clinic, showing improvements in medical care in the late 1800s. According to Makary, the latter painting captures the transparency movement of modern day healthcare. He then questioned how things have been done historically in medicine and suggested ways to change inherent cultures.
In the field of laboratory medicine, Makary suggested that collaboration across specialties will become increasingly important. Academia is uniquely suited for such a transition, as it is an optimal place for partnerships between clinicians, laboratorians, and basic researchers, he said. Such a partnership emphasizing quality, invention, and transparency—focused on improving patient outcomes—will continue to revolutionize healthcare.