Through the looking glass: a practical path to improving healthcare through transparency places three Nordic nations – Denmark, Finland, and Sweden – at the top of the transparency rankings, with the UK in fourth place, alongside Norway, Australia, Netherlands, New Zealand, Portugal and Singapore. KPMG rated nations’ healthcare systems on the availability of data across six dimensions of transparency, including quality care, financial performance and governance.
The NHS picture
The NHS comes joint fourth in the global transparency index. The report argues that transparency is associated with mostly improved outcomes, giving the UK’s reporting of cardiac mortality for surgeons as an example. The UK has also been a global leader in publishing patients’ feedback about the impact of treatment on their quality of life.
The NHS receives its highest score – 85% – for transparency in patient experience. In fact, the NHS’s scores in this area were only beaten by one other country. Jason Parker, head of health for KPMG in the UK, explained why: “The NHS introduced the ‘Friends and Family Test’ in 2013, where all patients are asked to rate their experiences based on whether they’d recommend their place of care to their friends and family. Providers have targets to meet, which actively encourages them to ensure patients answer the test.” The primary objective of the test is to make this feedback publicly available on NHS websites so patients and the public can use the information to make choices about hospital care.
Following close behind patient experience, the NHS scores highly for transparency on finances, with a score of 83%. Transparency data in this area includes published annual reports with independently audited accounts, and the disclosure of payments, gifts and hospitality to healthcare staff.
The NHS received its lowest scores – 57% – for the level of access that patients have to their own medical records, lagging behind countries like Singapore and Spain.
“The NHS’s scores for ‘personal healthcare data’ may be lower because there has been opposition by patients themselves to share their data across providers. This has worked well in other countries at improving both the outcomes of care, and providing a more efficient service” added Jason Parker.
“Our ambition is to make the NHS the safest health system in the world – an ambition that will only be achieved by creating a culture of openness and honesty. This research shows we are making great progress in making sure patients are placed at the heart of the NHS by valuing their feedback and empowering them with information about the services they use, so we can make sure they receive the best care possible. But we can go further which is why all NHS Trusts from this month are required to publish how many deaths they could have avoided had care been better, along with the lessons that they have learned” said Health Secretary Jeremy Hunt of the findings.
The global picture
The report argues that there is room for improvement in global health transparency, with even the high performers lacking consistency across all forms of transparency. “The findings show that health systems are struggling to make the most of transparency,” said Mark Britnell, Chairman of KPMG’s Global Health Practice and a partner with KPMG in the UK. “As part of our global index reveals a patchwork of efforts that often lack strategic coherence.”
The study also highlights big variations across several dimensions of transparency. ‘Governance’ and ‘Finance’ indicators scored the highest across six dimensions globally, while data on ‘Quality of Healthcare’ was the lowest – suggesting this is the area where health systems are most cautious to release data.
“There is no consensus on what transparency in healthcare looks like,” KPMG’s Britnell continued. “We see a wide range of interpretations based on country, care setting and stakeholder group, which reflects a lack of strategic clarity about what it is for and how to use it as an improvement tool. It’s time that it was seen less as political force and more as a tool to improve healthcare – albeit one that can have negative effects if used ineptly.”
Transparency: a force for good…and for ill
KPMG’s global study found plenty of good examples of transparency in practice, with evidence that public reporting stimulates quality improvement activities, especially at the hospital level. Publishing performance data, however, produces mixed results, in some cases leading to improved health outcomes, and in other instances resulting in negligible or potentially worse outcomes. The practice of ‘naming-and-shaming’ is particularly contentious, with many practitioners concerned that it is demotivating and divisive.
“Our conversations with healthcare professionals also show that unreliable data is a major problem,” added Jason Parker. “Publishing data about a health system is not helpful – and can even be harmful – if that data is incomplete, inaccurate, out-of-date, or not comparable. The wrong conclusions can be drawn and inappropriate actions taken, which generates further resistance to transparency, because physicians fear they will be unfairly labelled.”
The sheer volume of data can also prove quite a distraction, with the range of metrics expanding to a point where significant amounts of resources and money are devoted to collecting and analysing numbers that are never really used. “Some hospitals we looked at are delivering as many as a thousand performance indicators,” added Jason. “Not only are these frequently of poor quality, but it’s almost impossible to highlight the data that is really important to clinical improvement. If current trends continue, health systems could be overwhelmed by data requirements that distract from the real business of healthcare improvement.”
Imagining a brighter future for healthcare transparency
Transparency may not have delivered on its promise, but that doesn’t mean it’s going away. As the report emphasises, the trend towards greater transparency is inevitable, given the explosion in the amount of healthcare data and rising consumer expectations of patients and the public.
KPMG’s Britnell said that, to realise the full value of this trend, a ‘whole-system’ approach is needed. “If health systems want transparency to fulfil its promise to improve quality, they need a more disciplined, long-term approach. This means measuring what really matters, taking a selective, phased approach to data publication, learning from other innovative providers and promoting high trust cultures.”
For additional information or to view “Through the Looking Glass: A Practical Path to Improving Healthcare Through Transparency” click on the link https://goo.gl/As2Kc8.