Health And Behavioral Science

Health
Should Care
Be Transparency
About Strategy, Not
Marketing
by Thomas H. Lee
May 21, 2015

Health care organizations need to re-think their concept of

strategy to thrive in a marketplace driven by competition on value
– how well they improve patient outcomes and reduce costs. That
re-thinking begins with clarifying what the organizations are
truly trying to accomplish, and for what “customers,” and how
they are going to distinguish themselves from competitors and
offer a unique value proposition. Make no mistake – improving
value for patients is hard. But as Michael Porter and I write in our
recent Perspective article in The New England Journal of
Medicine, “Why Strategy Matters Now,” providers are unlikely to
succeed if they cannot focus on this goal.

This critical question of organizational goal applies to how

providers think about transparency – the growing trend to make
their own performance data public. What are they trying to
accomplish when, for example, they publicize surgical success
rates or patient experience data and comments? Are they focused
mostly on marketing (aka “reputation management”), or are they
trying to improve their actual performance by engaging patients
and caregivers with complete and objective data?

The answer is important, because the transparency movement

will be a game changer. For years, most provider organizations
were skeptical about whether “quality” could really be measured,
and many resisted public reporting of any performance data or
tried to focus their data collection on process measures that they
could control. (I make these comments with appropriate humility,
having at times pushed as a clinician and health care executive
for “translucency” more than transparency in the past.)

The problem with translucency – in which selected data are

released, but are presented in ways that make details difficult to
discern – is that it isn’t particularly helpful. Patients can tell that
they are not getting the complete story, and clinicians are not
pushed to improve. For example, like their organizations,
clinicians are most comfortable with transparency around
measures that they can control (e.g., use of beta blockers after
heart attacks) but the resulting data do little to distinguish
performance differences among providers on what really matters
– how their patients fare. This adds to skepticism among both
clinicians and their organizations about the value of public
reporting.

Now, however, an increasing number of health care organizations

are publishing detailed data on patient outcomes, especially for
major surgical procedures. And the University of Utah Health
system has pioneered publication of data on patients’ experience,
including virtually all patient comments. Others are following
suit.

As provider organizations become transparent with their data, the

question that each should ask is fundamental: Is the target the
patient, and is the goal, simply, to paint a rosy picture? Or is the
real goal to build patient trust by sharing true performance data
and, in doing so, to help clinicians improve? When performance is
on public view, everyone does their best work. And when
providers receive this constant feedback on their performance,
they’ll strive to get even better.

Engaging in improvement-focused – rather than marketing-

focused – transparency is hard work. It requires organizations to
rigorously collect data from as many patients as possible and to
analyze it with the best available tools and benchmarks. It
requires that the resulting data be displayed with unflinching
honesty. And it requires that organizations make clear that the
transparency effort is intended, above all, to drive improvement.
If “transparency” initiatives have a different primary goal, they’ll
only inspire cynicism.

Thomas H. Lee, MD, is the chief medical

officer of Press Ganey. He is a practicing
internist and a professor (part time) of
medicine at Harvard Medical School and a
professor of health policy and management at
the Harvard T.H. Chan School of Public Health.
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