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AAMC 2014: Transparency Leads to Accountability

When you make data public, you make a commitment to hold your organization to a higher standard. That is the message of David Entwistle, CEO of University of Utah Hospitals and Clinics as he discusses the culture shift that occurred when the decision was made to start posting doctor reviews online, and how it has led to a renewed commitment to quality care.


Interviewer: There is a lot of talk about transparency in health care these days. What exactly does that mean? That's next.

Announcer: Broadcasting from the Algorithms for Innovation booth at the AAMC in Chicago. The Health Care Insider is on The Scope, University of Utah Health Sciences Radio.

Interviewer: David Entwistle is the CEO of the University of Utah Hospitals and Clinics. David, what do you think the forces are both internal and external driving transparency in health care today?

Entwistle: Well we have a lot of opportunities to always constantly improve in healthcare. As we look at areas where we are either deficient and now we're trying to make improvements in terms of both the patient experience or even coming down to what we're looking at cost. The challenge that we have is that the data, the information to make critical decisions and quite frankly hold ourselves accountable to move forward is not always there. We have done some things to create data systems within our own models but there are more oriented around some of the financial matters. What we're looking at is what are some things we need to improve on and how do we make that data available.

Quality is a great example. Quality is one of those areas where the data is not transparent. We haven't been particularly visible in it. We're going to be looking data, exceptional patient experience data, how do we get that out more in formats where we can use it to make changes within our organization for the better?

Interviewer: University of Utah Health Care has been on a transparency journey for the past six years. Tell me a couple of the most important lessons you have learned along the way.

Entwistle: I love that the statement you used, journey. That is definitely one of the things we're looking at because it is one of those pieces that take time. When you're changing the culture within an organization, you should expect a journey. You should take time. Its not something that is immediate or overnight.

We have been on some fairly significant journeys within our organization. One certainly around our patient experience or what we call is our EPE, our Exceptional Patient Experience. We have tried to again make the data very transparent in terms of in how we as individual providers or how we as organizations are doing in various different areas. Making that data in a format that can be very useable to the end users, but also to make it visible on even a monthly basis, or even weekly basis.

One of the things we have had to do is even increase the number of surveys we send out. We're looking at online surveys that we do to get more of a response. But it has been a journey, so there is a lot of aspects to how you create a greater data sources but even creating greater apparent formats for people to be able to use. So a lot of different perspectives there.

Interviewer: Right. As you mention transparency requires some culture change. I'm wondering how quickly, or how slowly we go about driving transparency?

Entwistle: Culture is one of those aspects that you have to have patience with the process sometimes. Understanding where your organization is at. How readily open are they to data? For example, when we began producing data by individual physician on their Exceptional Patient Experience scores, we actually blinded the data. We had physician A through Z, so to speak. It became apparent pretty quickly that individuals wanted to know how they were performing. We were able to then get that data out in a format with individual physicians and providers names on it.

So again, how does your culture, how readily acceptable is it to change? How readily acceptable is it to this transparency piece? You have to set the pace based on how successful you can be as an organization. You can't move too quickly. You also can't move too slow based on the environment and the market and what is going on around us. You have to be able to create that transparency moving forward and use that as a model based on where your culture is at, what's best, what they're able to respond to.

Interviewer: At the end of the day this is all about improving patient care. How do you think these efforts around transparency are going to make a difference to the patient?

Entwistle: We have to move in this direction. I mean the reality is that we have been too insular too long within health care. We understand the data internally and we do a lot from that perspective to get that data out from the perspective of the way we like to look at it especially from the quality side. We talk about mortality scores, we talk about infectious rates, better measures.

From a perspective of a patient, they don't value that or see that as something that they even understand. Not that they couldn't but again we haven't done the time to educate them on what is important. So how do we get the data in such a format and what are meaningful measures to them so that we can really use that data to help them better appreciate and understand where we are going. Also, internally so we are measuring the right things to make change.

Interviewer: There is a sense I think that health care systems and payers really want to keep the data proprietary and not share it when it comes to cost or quality as you mentioned, or patient satisfaction. Is that true?

Entwistle: There is certainly value in the data, and there are a lot of companies out there now that are using big data as you call it to develop analytic tools. Develop processes systems and new ways of doing things based on the data they're seeing within their own system. Certainly, I think we have been reticent to share data more widely in the past because of the worry about what that data may show internally, here are the things we are doing well or maybe in some cases not so well.

We really have got to get past that. We have got to be able to use the data in a transparent way to make changes, to identify where we are going. And it's going to quite frankly a culture we're going to have to get over internally of not sharing that data. Understanding that we do have challenges that we are going to need to work on; and unless we get that information out in front of people, we're not going to make those changes. If we're not cutting the data in the right way even to see where we're improving or not improving. We've got to move all of that within the organization and be more transparent.

Interviewer: Isn't it interesting that so much of this data is really about the patient? It is sort of owned by the patient. What do you think of it being held by a system or an outside party?

Entwistle: Obviously it is data on the patient and they have access to it. The real power of the data though is when you look at it in an aggregate. If you look across thousands of patients, what are the outcomes of what they are seeing based on whether you are looking at standardized practices or standardized ways of looking at care. The challenge is, not all the care is standard, so how do you look at those nuances that are more effective? How do you look at the individual variation and what does that mean? In some cases, that is how we look get to some of the care processes that we're going to in order to create a greater quality and greater patient experience and even some of the cost savings.

Announcer: Sparking conversations to transform academic medicine. For more, stop by our booth at the AAMC or go to, the University of Utah Health Sciences Radio.


By: Amy Albo

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