Correspondence |
Discordant public and professional perceptions on transparency in healthcare
Sir,Transparency is becoming a major issue in healthcare.1,2 Recent work shows substantial differences between views of physicians and those of the public on medical errors:3 while the public views open reporting as a very effective way of reducing errors, physicians prefer confidentiality. We conducted a survey to evaluate the potential contribution of a disclosure policy to hospital image. Our findings shed additional light on the discordance of opinions between physicians and the public.
We conducted a phone survey (in Hebrew, Russian and Arabic) of a representative sample of the Israeli public (n = 570) using random-dial software. Respondents were asked to predict the effects of a transparency policy upon public image of hospitals and doctors, and also to what extent physicians report mistakes.
In addition, we conducted 115 face-to-face interviews of physicians with questions similar to those of the public survey, in three major teaching hospitals (two from Israel, one from the US). They included 53 residents, 54 attending physicians (from internal medicine, surgery and gynecology), six department heads and two hospital directors.
The majority of the public indicated that an open disclosure policy would enhance the image of hospitals (Figure 1). By contrast, a majority of physicians predicted that disclosing mistakes would damage the image of the hospital (p<0.001 vs. the public). American and Israeli physicians had similar distribution of opinions.
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Since Israel has a markedly heterogeneous population, we examined whether ethnic or social groups might have different answers. In all subgroups, including Russians, Arabs, and people with low or high levels of education, the majority consistently responded that transparency would benefit hospital image.
Both the public and physicians thought that disclosure to patients of individual mistakes by doctors would enhance the doctor's image. The public thought that in fact, few or none of the doctors disclose errors, whereas both Israeli and American physicians felt disclosure was common (p<0.001). The public and the physicians agreed that publication of performance data would improve hospital image.
Our survey suggests that while physicians from both sides of the Atlantic Ocean share scepticism about the value of transparency, people from very diverse backgrounds share convictions regarding its importance. As discordance between public and doctors seems to cross cultures, bridging over mistrust appears to be a global challenge. It seems that both the public and physicians know physicians make mistakes, but physicians may not yet fully appreciate the extent of this public understanding.
Transparency in itself appears to become, in public eyes, an indicator of quality. ‘Tell the truth and tell it fast’4 should become standard in healthcare, as recently adopted in Australia,5 but this cultural shift may be a tough professional challenge.
This work was presented at the annual meeting of the American Public Health Association in Washington, November 2004.
Hebrew University Medical School Jerusalem
Department of Communication Tel Aviv University
Center for Quality & Safety Hadassah University Hospital & School of Public Health Hebrew University Ein Kerem Jerusalem Israel e-mail: brezis{at}vms.huji.ac.il
References
1. Smith R. Transparency: a modern essential. Br Med J 2004; 328:editorial.
2. Mazor KM, Simon SR, Yood RA, et al. Health Plan Members’ Views about Disclosure of Medical Errors. Ann Intern Med 2004; 140:409–18.
3. Blendon RJ, DesRoches CM, Brodie M, et al. Views of Practicing Physicians and the Public on Medical Errors. N Engl J Med 2002; 347:1933–40.
4. Augustine N. Managing the crisis you tried to prevent. Harvard business review on crisis management. The Harvard business review paperback series. Boston, Harvard Business School Press, 2000:1–31.
5. Australian Council for Safety and Quality in Health Care and Standards Australia International. Open Disclosure Standard: A National Standard for Open Communication in Public and Private Hospitals, Following An Adverse Event in Health Care. [http://www.health.wa.gov.au/safetyandquality/docs/ACSQHC_Open_Disclosure_Standard.pdf].
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