A Star System for Hospitals – Helping Patients Make Informed Decisions

August 15/14
Patti Ryan


Accessing health care may cause the following:

  • Death – Medical mistakes are the fifth leading cause of death in the US
  • Harm – As many as 25% of all patients are harmed by medical mistakes
  • Injury – 3-17% of patients will experience an injury as a result of their care
  • Unnecessary Procedures – Approximately one quarter of all medications and medical procedures may not be necessary
  • Unnecessary Risk – Many patients who are candidates for minimally invasive surgery are never told of their options and instead have more extensive surgery with greater risks

According to two highly regarded health care experts in the United States, we should all be better informed advocates for our health care. In fact, an empowered patient is seen by both learned professionals as a key driver to improving quality and avoiding being one of the statistics above. Wouldn’t it be great if we could research the quality of our hospital before we go in for elective surgery, in the same way we check out a hotel or restaurant before we go there. What about a ‘star-system’ for hospitals? Secret shoppers/patients? Anonymous critics? In his book, UnaccountableMarty Makary, MD chronicles what hospitals won’t tell you and how transparency can revolutionize health care. He shares a great deal of frightening anecdotal evidence from his years as a resident and is a vocal advocate for ‘sunlight being the best disinfectant’. Dr. Makary makes a compelling argument for hospitals publishing a range of quality indicators including:

  • Bouncebacks (readmissions to hospital)
  • Complication rates (e.g. what is the post-surgical infection rate)
  • Never events (e.g. having surgical equipment left inside of you or operations done on the wrong part of your body – should NEVER happen)
  • Safety culture scores (% of hospital staff who would want to have surgery at the hospital they work at – yes there are surveys out there that capture that) and;
  • Hospital volumes (how many surgeries does the hospital do in a year – practice makes perfect).

Dr. Makary promotes ‘open notes’ as one solution to the quality crisis in health care. “Being able to review your doctor’s notes in writing might be even better, particularly if you could add your own comments, perhaps via the web. Transparency plus collaboration puts patient and doctor literally on the same page so people no longer have to wonder what their doctor is thinking or whether it radically diverges from what they understood.” Donald Berwick played the role of critic in his book, Promising Care How We Can Rescue Health Care by Improving It. Donald is past president and CEO of the Institute for Healthcare Improvement (IHI) and is a well-recognized expert on healthcare quality internationally (currently running for Governor of Massachusetts). In his recent book in the chapter ‘My Right Knee’, he tells the story of his own experience with the healthcare system when he required knee surgery. If you only read one chapter of this book, read that one (although the entire book is excellent). Donald puts into print what all of us would like when we are faced with surgery, an agreement with the surgeon on what he/she will/will not do. This was what Donald (international expert on health care quality) wanted from his surgeon:

  • No needless death – don’t kill me
  • No needless pain – don’t hurt me
    •  Don’t do stuff that won’t help me
    •  Don’t repeat things that have already been done
    •  Don’t leave me worse off than when I arrived
  • No helplessness – don’t make me more vulnerable
  • No unwanted waiting – my time is as important as yours
  • No waste – give me effective, efficient, necessary care

In one of his IHI keynote addresses published in his book, Donald spoke of his personal experience as a patient and in so, provided a solution to reducing health care quality risks. “The two most important ways to prevent helplessness are to share information with me and to give me choices. First, keep me posted. That’ll begin with my medical record. No one can touch my knee who won’t give me my medical record to read anytime I want it, no questions asked, and no delays. Better yet, let me keep my record with me, and I’ll let you use it anytime you want.” These are two great books that everyone should read. I accidentally read them back to back and was impressed by the common elements that these two experts shared. While they often present polar opposite perspectives of the same problem, (one glass half full, one glass half empty) both are right. After reading Makary’s book I would be afraid to enter a US hospital but after reading Berwick’s book, I’m reassured that quality abounds in the system. One shining a spotlight on the problems one focusing on the solutions, both recognizing the importance of patients advocating for quality health care.

Your Health. Your Health Information. Manage it Well.