Paul Levy, CEO of Beth Isreal Deaconess in Boston has been blogging about a number of issues he deals with trying to transform a very large health care institution---with a very typical, very well entrenched institutional bureaucracy.    His posts belay a man who appears quite capable of handling the tasks at hand.  In an article in Business Week, Paul discusses the issues surrounding the concept of transparency in healthcare administration---to improve the care rendered by an institution, its physicians and its staff. 

Some will believe that transparency in health care refers to reports about how one hospital deals with certain disease states in comparison to its nearby competitors.  Levy further believes that most healthcare administrators beleive   transparency (on the the institutional level) will allow them to utilize the information as a competitive tool. 

As he points out, both concepts are off base.

Transparency's major societal and strategic imperative is to provide creative tension within hospitals so that they hold themselves accountable. This accountability is what will drive doctors, nurses, and administrators to seek constant improvements in the quality and safety of patient care.

Paul has taken this concept to heart and recently and openly suspended a top physician on his staff for failure to follow certain institutional guidelines meant to protect patients. He has published his hospitals infection rates on his blog and asked his fellow CEOs in Boston to follow his lead.  This was met with open hostility.  No one believed he was "opening the books" for non-competitive reasons.  

Transparency (accountability) is the hallmark of an overall campaign to create a culture of safety within a medical institution.  As the IHI points out---the key points to creating a campaign of safety include a process...

Based on trust, human rights, repentance, and forgiveness.
Patient and family centered.
Supports staff, enabling and motivating the highest levels of performance.
Acknowledges the high-risk and error-prone nature of health care.
Ensures individual and shared acceptance of responsibility and accountability.
Encourages and facilitates reporting and open communication about safety concerns in a fair and just environment.
Ensures that organizational structure's processes, goals and rewards are aligned with improving patient safety.
Learns from errors.
Shares stories.

  In his post, Paul continues along the same lines and adds...

How you cultivate this creative tension over time:

Benchmark against the best practices.
Search for opportunities to be humbled.
Learn from the tragedies of others.
Keep patients and direct care staff "in the room", i.e., engaged in evaluation and decision-making.
Conduct critical risk assessments.
Story telling and learning.
Constantly look for trouble.
Be transparent.
Get information to those who need it to drive change.

Paul is very unique in terms of how he embraces transparency(and accountability) in healthcare and in his belief that it will work to improve the quality of care rendered by an institution on all levels.  I commend him for his efforts, his brilliance, his openness and his ability to transform a system in need of a dramatic change.