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Cleveland Clinic and University of Utah Embrace Transparency to Drive Change


Transparency is a trending word in health care these days and one that is packed with possibility. Executive Editor of The New England Journal of Medicine Gregory Curfman, M.D., boiled it down to this: providing patients with information and involving them as full partners in decision-making. That definition of transparency, which he gave in his introductory remarks at the roundtable discussion entitled “Innovation in Health Care Leadership: Transparency in Quality Data, Pricing, and Medical Records,” fundamentally changes the physician-patient relationship from a beneficially authoritarian, paternalist doctor-patient relationship to one in which the patient is fully informed and the provider has elicited patient preferences and goals. That new relationship hinges on one thing: that payers and providers give patients access to information. The public is eager for it and now providers and payers need to figure out how much and how best to provide it.

As Press Ganey’s Chief Medical Officer Thomas Lee, M.D., has said, “The arc of history is clearly in the direction of transparency.” The roundtable, co-sponsored by The New England Journal of Medicine Group and Harvard Business Review, had a panel packed with who’s who in health care from throughout the country who are disrupting the current asymmetry of health information by embracing transparency in three different areas: quality data, pricing, and medical records.

Amy Compton-Phillips, M.D., chief quality officer of Kaiser Permanente, led the first discussion on provider-driven, quality data transparency, calling her guests, Delos “Toby” Cosgrove, M.D., and Vivian S. Lee, M.D., Ph.D., M.B.A., “disruptive forces counteracting paternalism through transparency.”

When Cosgrove became CEO and president of the Cleveland Clinic 10 years ago, he tapped into his experience as a cardiac surgeon. “In cardiac surgery, we measured everything,” said Cosgrove. “We learned from our mistakes, improved and eventually created outcomes books and a national outcomes registry. It was our responsibility to the public and to our colleagues.”

Cosgrove wanted to bring that level of rigor of quality and transparency to the entire system, and asked each of the chairs of the Cleveland Clinic’s Institutes to do the same. He knew that the data was not so clear-cut in other specialties, so he asked each institute to develop their own set of metrics to measure quality and then make those outcomes available to the public. Today, Cosgrove said, the Institutes publish outcomes books that include around 1300 metrics. The books are widely distributed online and half a million books are printed.

Sharing outcomes data not only showed responsibility to the public, Cosgrove said, but also helped motivate physicians to change behavior and improve. “Data and peer pressure works with doctors,” said Cosgrove, who thinks it’s important to give physicians a sense of where they stand compared to their peers. “No one wants to be last in the class or last in a quality metric.” From a system perspective, the data allows them to celebrate the top 10 percent and manage the bottom 10 percent.

On a parallel track to transparency, Lee, Senior Vice President for Health Sciences, Dean of the School of Medicine and CEO of University of Utah Health Care, showed how data and transparency have been used to engage physicians, change culture, and transform the system into a value-driven organization by first improving the patient experience and then tackling costs.

The University of Utah’s data transparency journey began in 2008 with Lee’s predecessor, Lorris Betz, M.D., Ph.D., who launched a campaign to improve the patient experience. “You can’t be a great medical center if your patients don’t think you’re great,” said Betz, pointing to the system’s 18th percentile ranking for patient satisfaction. Transformation began by rigorously collecting data, via Press Ganey surveys, and then making it increasingly transparent to providers so they could see first their own scores and then how they ranked with their peers. “Most providers don’t like having all red,” said Lee. “They have the desire to improve but not the skills to get there.” The system then focused on providing enterprise-wide Lean training and leadership development to empower providers to change.

In December of 2012, Utah took transparency to the next level and became the first academic medical center to post patient satisfaction scores online with a familiar five-star ranking and patient comments. Lee said they filter less than one percent for defamatory comments.

The end game, Lee said, is to create value by linking patient satisfaction data and outcomes data with cost. That’s no easy task, since true cost data, not just charges, is scattered throughout the system. Two years ago, Lee sequestered a “crackerjack team” to develop a tool, called Value Drive Outcomes. The tool, called VDO, harnessed all of the institution’s data and organized it into a Web-based platform that provides a visual way to look at cost and variability for any given procedure and then drill down to specifics. The plot twist, said Lee, is that transparency with costing data helped providers define new quality and outcomes metrics, which is what they really care about.

Both leaders believe that data transparency and physician engagement are fundamental to success. Having good data, making that data transparent and putting it into the hands of providers has been transformative, said Lee. We need to give physicians tools, and the first tool is data, said Cosgrove. Not just any data, but data they believe and think are important. Lee added that we need to shift the paradigm of looking at data as a “gotcha” moment.” “It’s incredibly satisfying for providers to look at positive comments,” said Lee, and provides a great learning opportunity.

At end of day, it’s providers who lead health care organizations, Cosgrove said. We need to help them understand what the journey is. Communication is an enormous aspect of this. Lee agrees: “When trying to motivate this change, it’s so important to realize that the answers and the solutions are in the hands of providers. If we can unleash that capacity, transformation is going to be possible.”

It’s a journey of a thousand, halting difficult first steps, but we pick up cadence as we go along, said Cosgrove. The driving force to change is to provide better outcomes and better experiences – both physical and emotional – for patients. They’re our North Star when we come to fork in a road, he said. We’ll always make the right decision if we keep the patient in mind.

The New England Journal of Medicine Group and Harvard Business Review co-sponsored a roundtable discussion entitled “Innovation in Health Care Leadership: Transparency in Quality Data, Pricing, and Medical Records.” The event, hosted at the Massachusetts Medical Society in Waltham had both a live and online audience. Watch the full video above.

By: Amy Albo

Amy Albo is a director for special initiatives and projects for University of Utah Health Sciences.