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Creating a culture of data acceptance and external accountability

Patient Safety Quality Monthly, October 23, 2007

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The two common and related themes affecting our healthcare culture today are accountability and transparency in regard to quality and patient safety. The government, regulators, employers, and consumers are all demanding greater accountability of healthcare organizations and individual providers through greater transparency of information. This is a difficult transition for most of us because we have had a long tradition of a lack of questioning of what we do and how we do it. This culture of autonomy pervades our professional views as caregivers and managers. It is not surprising that this loss of autonomy is causing real anguish.

There is no sign that this loss of autonomy is a passing fad. The movement to provide publicly available data about clinical practices and outcomes through The Joint Commission, CMS, and state initiatives is growing. In addition, external data are driving reimbursement through pay-for-performance programs. And the reason this movement will not retreat is because external accountability through publicly available data has worked to change practices.

So what should we do? The answer is we need a culture that can adapt to this new order. There are three types of cultures related to external data:
1. Resistant
2. Tolerant 
3. Embracing

I suggest that the organizations that will survive will be the ones that adopt the third approach-embracing. Those organizations will say, "Bring it on! Give us all the data you have as soon as we can have them." They will seek to be ahead of the curve.

How can you create such a culture? Let's review and apply the four stages of loss to this question. They are: denial, anger, depression, and acceptance. There is a real loss of some of our autonomy through external data that show  something about us that we may not want to know andshare that information with the rest of the world. Just like the loss of a loved one must be addressed before a person can move on with  his or her life, this loss of autonomy must be acknowledged and managed.

Next, leaders-both hospital administrators and physicians-must strive to create a new culture of acceptance of external accountability. Here are three actions that we have learned from healthcare experience that can make a difference in a patient satisfaction culture:

1. Set behavioral expectations for external data use
- No "pity parties" about data validity or burden
- No dismissal of the data because of reputation
- No superficial excuses about performance-only analysis and action
2. Keep everyone informed, even if the results are poor
- Distribute data widely and publicly
3. Set clear targets for excellence, not just acceptable performance
- Celebrate and reward improvement but don't lose focus on the goal

So, where is your hospital or medical staff culture at today regarding external accountability?  Where do you want it to be in five years? I realize that these aren't the only things you can do. But they are a good start.

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