Transparency is a popular word these days, and it’s fast becoming an expected feature at all levels of healthcare. Transparency requires a clear and accepted understanding of a concept as well as guidelines and expectations for how healthcare organizations and providers should apply the concept to their work as an emerging issue evolves.
Here are some ideas about how nurses could consider the concept and its application in practice.
What is transparency and why now?
In operational terms, the concept of transparency addresses access to information. The first and most pressing rationale for transparency is the role that information plays in decision-making and trust-building.
In the April 2010 Harvard Business Review, Meyer & Kirby suggest that, as the impacts of various business on organizations become too substantial to ignore and as techniques to measure those impacts develop, businesses start getting measured. A patient-driven movement was the main impetus for transparency in healthcare. Patients and payors began demanding information on outcomes and respect for patient’s rights.
Transparency on a national level
Responses to the demand for transparency in healthcare began in the late 20th Century, resulting in a variety of national initiatives, such as:
- The National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: A Federal program intended to improve the quality of health care by encouraging state licensing boards, hospitals and other healthcare entities, and professional societies to identify and discipline those who engage in unprofessional behavior. It restricts the ability of incompetent physicians, dentists, and other health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payments and adverse action history.
- Hospital Compare: A program that provides information from hospitals on how well they provide recommended care to their patients.
- The Joint Commission: A voluntary accrediting body that provides accreditation status information on hospitals.
What states are doing
Pennsylvania has led the way by establishing the Pennsylvania Health Care Cost Containment Council (PHC4). The PHC4 is an independent state agency that publicly reports hospital performance and medical procedure outcomes.
Organizations expended much effort and expense to develop data collection and reporting mechanisms that met the public reporting requirements of the national and state initiatives. Now, individual organizations are looking at clinician performance and patient outcome data.
Automated medication administration systems and electronic medical records capture clinician-specific information and match it with specific patients, the care that the clinician provided those patients, and the patient’s outcome.
What does transparency mean for nurses?
Nurses can take the lead in their organizations to press for policies and guidelines that identify the goal of transparency. Specifically, what are the kinds of information that need to be communicated during certain situations? Nurses can study and suggest the appropriate level of transparency to be applied to each particular type of information.
Milton (2009) suggests the following steps:
- First, transparency needs to be defined in a practical manner as a desired communication goal and outcome. Possible limits to transparency also need to be identified and articulated as part of the policy.
- Second, the policy needs to be applied to the relevant information that an organization may generate or gather, and that the public will need and may seek, during an emergency.
- Third, responsible staff could then identify practical dissemination tactics in their communication plans to reach the various audiences with appropriate information.
What expectations are there of you?
With your practice in mind, consider your responsibility and the expectations about transparency that both an employee and an employer would have. Ask yourself these questions:
- Who are your stakeholders?
- What information is revealed?
- What information should be revealed?
- To whom should what information be revealed?
- How should information be revealed?
- Who should reveal the information?
- When should information be revealed?
- To what policies and procedures are you currently bound?
Meyer, C & Kirby, J. (2010). Leadership in the age of transparency. Harvard Business Review, 88 (4), 39 – 46.
Milton, C. (2009). Transparency in nursing leadership. Nursing Science Quarterly, 22 (1), 23-26.
I’d like to hear from you. What are your experiences and challenges with transparency? Please share your questions or strategies with your fellow readers by sending them to me at firstname.lastname@example.org. I look forward to hearing from you.
About the Author: Betty Nelson, PhD, RN, a registered nurse with more than 30 years experience as a clinician, administrator and educator, is an adjunct professor in Health Sciences and Nursing at American Sentinel University.