Health Care Transparency Should Be About Strategy, Not Marketing

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Health care organizations need to re-think their concept of strategy to thrive in a marketplace driven by competition on value – how well they improve patient outcomes and reduce costs. That re-thinking begins with clarifying what the organizations are truly trying to accomplish, and for what “customers,” and how they are going to distinguish themselves from competitors and offer a unique value proposition. Make no mistake – improving value for patients is hard. But as Michael Porter and I write in our recent Perspective article in The New England Journal of Medicine, “Why Strategy Matters Now,” providers are unlikely to succeed if they cannot focus on this goal.

This critical question of organizational goal applies to how providers think about transparency – the growing trend to make their own performance data public. What are they trying to accomplish when, for example, they publicize surgical success rates or patient experience data and comments? Are they focused mostly on marketing (aka “reputation management”), or are they trying to improve their actual performance by engaging patients and caregivers with complete and objective data?

The answer is important, because the transparency movement will be a game changer. For years, most provider organizations were skeptical about whether “quality” could really be measured, and many resisted public reporting of any performance data or tried to focus their data collection on process measures that they could control. (I make these comments with appropriate humility, having at times pushed as a clinician and health care executive for “translucency” more than transparency in the past.)

The problem with translucency – in which selected data are released, but are presented in ways that make details difficult to discern – is that it isn’t particularly helpful. Patients can tell that they are not getting the complete story, and clinicians are not pushed to improve. For example, like their organizations, clinicians are most comfortable with transparency around measures that they can control (e.g., use of beta blockers after heart attacks) but the resulting data do little to distinguish performance differences among providers on what really matters – how their patients fare. This adds to skepticism among both clinicians and their organizations about the value of public reporting.

Now, however, an increasing number of health care organizations are publishing detailed data on patient outcomes, especially for major surgical procedures. And the University of Utah Health system has pioneered publication of data on patients’ experience, including virtually all patient comments. Others are following suit.

As provider organizations become transparent with their data, the question that each should ask is fundamental: Is the target the patient, and is the goal, simply, to paint a rosy picture? Or is the real goal to build patient trust by sharing true performance data and, in doing so, to help clinicians improve? When performance is on public view, everyone does their best work. And when providers receive this constant feedback on their performance, they’ll strive to get even better.

Engaging in improvement-focused – rather than marketing-focused – transparency is hard work. It requires organizations to rigorously collect data from as many patients as possible and to analyze it with the best available tools and benchmarks. It requires that the resulting data be displayed with unflinching honesty. And it requires that organizations make clear that the transparency effort is intended, above all, to drive improvement. If “transparency” initiatives have a different primary goal, they’ll only inspire cynicism.

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