Lucian Leape Commentary: Transparency and Public Reporting Are Essential for a Safe Health Care System

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In a new commentary, Lucian Leape, M.D., internationally recognized leader of the patient safety movement and adjunct professor of health policy in Harvard University's Department of Health Policy and Management, argues that, of the three major approaches to improving patient safety — regulation/accreditation, financial incentives, and public reporting of performance and feedback to health care providers — public reporting holds the greatest promise.

Leape discusses the example of central line–associated bloodstream infections (CLABSIs), a particularly lethal hospital-acquired complication. Despite strong evidence on how to prevent the infection, most hospitals still have significant rates of CLABSIs. According to Leape, the vast majority of hospitals have not implemented the Pronovost protocol — the standard in CLABSI prevention — "because they have not made a meaningful commitment to reducing preventable injuries, much less eliminating them."

For Leape, transparency is the key to motivating hospitals to do what we know makes health care safer. "From an ethical standpoint, the argument in favor of transparency is straightforward: the public has a vital stake in the outcomes of health care, and therefore it has a right to know how we are doing," he says. "Openness shows that the hospital feels accountable and has nothing to hide, which increases public confidence."

Next month, — the Fund's health care quality improvement resource — will feature data on rates of CLABSIs in some 900 U.S. hospitals.