One of the alarming facts about the epidemic of hospital harm is that too many providers do not, and/or are not required to, report medical errors, harmful incidents or even deaths as a result of breakdowns in patient safety. In fact, a report prepared by the U.S. Department of Health and Human Services’ Office of the Inspector General (OIG) in 2012 found that 6 out of every 7 hospital-based errors, accidents, and other adverse events still go unreported. Yet patient safety experts recognize that disclosure of errors and transparency in hospital practices is critical in creating and maintaining an informed healthcare public that can properly assess the risks to their health, and in creating a culture of patient safety as a result.
Time and again, patients and families who encountered medical harm report experiences of deception and stonewalling by the healthcare providers involved. Often, information was not disclosed before the harm occurred (for example, the risks associated with a particular drug) or there were efforts to cover-up what actually happened. More generally, too many hospitals hide behind a wall that deprives the public of important information which they need to make informed decisions about their care and about the performance of their healthcare facilities. In every case, when a curtain of opaqueness is allowed to separate medical facts from those affected, the healthcare safety of everyone is placed at risk.
The Center for Patient Protection notes that in one landmark case with which it is familiar, an elderly Canadian patient was subjected to more than 4,000 documented medical errors at two Canadian hospitals over the course of a continuous six-month hospitalization. This is a record for medical errors in a hospital setting which has no parallel in patient safety literature.
Yet the hospitals involved, including one of Canada’s most prominent teaching centers in Toronto, denied that a single error ever occurred and insisted that all care was “appropriate.” And although the family involved never commenced or threatened legal action, both hospitals resorted to lawyers to conduct their communication.
Regrettably, in 2014 the Obama administration discontinued a new requirement for the reporting of certain medical errors and infection rates in U.S. hospitals, which had come into force only a few months earlier under The Affordable Care Act. Patient safety experts fear what was starting to emerge was a picture that indeed confirmed the true scope of the epidemic of hospital harm. Healthcare lobbyists moved to prevent the real facts from coming to light.
In Canada, hospital reporting of medical errors is governed by a patchwork quilt of uneven regulations and practices. It is impossible to know, for instance, how many pressure ulcers are occurring in hospitals across Canada or whether there is a superbug outbreak. In many cases where reporting is required, hospitals get to pick and choose what areas they want to report on. There is the added fact, as noted previously, that Canada’s hospital data — when and where it is made available — is based strictly on self-reporting. There is no independent verification. The idea that Canada would have an official similar to the U.S. Inspector General for Medicare and Medicaid who could conduct a review that found substantial underreporting of harmful incidents in the hospital setting, and that those findings would attract the attention national legislators, is unthinkable. The idea that Canadian hospitals could be financially penalized for failing to follow certain safety practices, which happens regularly in the U.S., is equally beyond comprehension.
It would not be tolerated if governments suddenly stopped reporting passenger airline disasters, or never required them to be reported in the first place. Do we rely on airlines or railroad companies to determine what went wrong leading up to a crash or derailment, or to decide what information the public has a right to know? Even near misses must be reported in a public forum. Such transparency is considered to be in the public interest. Between the U.S. and Canada, the number of hospital deaths from avoidable harm takes a toll equivalent to several fully loaded jumbo jets crashing every week. Yet no one really knows precisely how many deaths or injuries occur, or why.
Patient safety and transparency go hand in hand. A hospital that will not acknowledge medical error, or worse, tries to cover it up, is one that will not learn from its mistakes. And that is a very dangerous hospital. The public has a right to such information in order to make an informed decision about what may be life and death matters — and to determine which hospitals might be contributing more to their life, or death.
For this reason, and because of the numerous experiences of harm that have come to its attention, as well as the life-altering personal experience that resulted in its founding, The Center for Patient Protection is a vigorous champion of changes both in hospital culture and in the law that will make healthcare systems more transparent and accountable, including those that support mandatory reporting of medical errors and harmful incidents.
It is truly time for the healthcare system to come out of the shadows.
From the public policy perspective, transparency is essential for accountability. Without full information, neither policy makers nor patients can know whether clinicians and their organizations are delivering safe, appropriate, cost-effective care.
From the quality and safety perspective, transparency is foundational for learning from mistakes and for creating a supportive environment for patients and health care workers. Transparency of all safety, quality, and cost data is also essential to the effective functioning of the health care delivery system. To make informed and costeffective decisions, all stakeholders—patients, clinicians, payers, providers, and policymakers—need to have full information in a form that is useful and understandable. If health care systems and clinicians don’t know about failures, they can’t fix them.
Not only does transparency promote accountability and improvement, but it lies at the heart of the relationship between a patient and his or her clinician. How can patients fully trust the clinicians and organizations from which they receive care if these clinicians and organizations are not fully transparent?
Without transparency, informed choice is impossible for either patients or payers. Without full, honest, open communication, patients cannot make informed decisions about their care or manage the resulting emotional and physical challenges when things go wrong. Moreover, transparency identifies best performers, allowing them to reap the rewards of their strong performance and allowing others to emulate their best practices. Patients have a right to full information about every aspect of their care. Without it, optimal care is an elusive dream.