High Reliability Series: The Need For TransparencyPosted: July 13, 2012
At 0:43 in the YouTube clip above, Bob Galbraith, MD, and Executive Director, Center for Innovation at the National Board of Medical Examiners says:
“If we don’t talk about our mistakes, we’re doomed to repeat them. Over and over and over again. So we have to have transparency and admit that we’ve made a mistake in order to prevent that mistake from ever happening again. And if we don’t do that, shame upon us.”
Transparency is a core characteristic of high reliability organizations. How can an organization improve if those leading the way do not expect and set the course for a culture that embraces honest assessment of operations and open, honest communication around the good, the bad and the ugly? The first step to change is admitting there is a problem–it’s Psychology 101. If organizations fail to admit, or even see, there is a problem the journey to high reliability never gets off the ground.
AHRQ has put out an excellent set of guidelines for the HRO journey, “Becoming A High Reliability Organization: Operational Advice For Hospital Leaders”. In it, Exempla CEO Jeff Selberg says that transparency is the key to culture change, and that an “unwillingness to face and share the hard facts is an indicator of denial, and denial is not compatible with a safe environment.”
Transparency sets the foundation and tone within an organization for every aspect of daily operations. Reporting of outcomes, reporting of near misses and unsafe conditions, management of medical error, interprofessional communication, patient-centered care–all of these operating procedures are limited, or reach new heights, in direct relationship to the level of transparency within an organization.
The challenge to create a truly transparent culture is a “must have” for any HRO–and as Paul Levy wrote in yesterday’s post, An Interest In Remaining Alive, a challange to hospital systems around the world. A healthcare culture that remains opaque will continue to harm patients–it’s occurring far too frequently in every corner of the globe. In the end, this is what we all swore to do when we received our MD–to first do no harm. Honing the characteristics of a HRO, starting with transparency, will help move healthcare to a state of being that will make patients feel they are as safe as they are on airplane when they enter a hospital.
More on transparency tomorrow…