Q&A: How WA hospitals are building trust in a new world of transparency

Mary Kay Clunies-Ross, Vice President of Communications & Public Affairs for the Washington State Hospital Association (WSHA), talks to State of Reform about the ongoing need for hospital transparency to increase patient health and safety, why rural health facilities are sometimes left out of the big data picture, and how hospitals can strive for sustainability without compromising quality.

Washington State Hospital Association is a nonprofit membership organization representing all 99 hospitals in the state, collaborating to find best practices in high-quality, cost-effective, and sustainable health care.

Mary Kay Clunies-Ross

Mary Kay Clunies-Ross / Source: wsha.org

JJ: The launch of the new WAHospitalQuality.org website seems successful. It is a beautiful site, yet when you are working to improve something as abstract as “transparency” in hospitals, how do you know if what you’re doing is working?

MK: Well, that’s a good question. With some of this [hospital transparency project] it’s hard to anticipate what the outcome is going to be, but you can’t postpone doing the right thing until you have all the metrics exactly figured out. We have long felt that making quality information available to the public was the right thing. And as the data gathering has improved, and basically the technological tools for data analysis has improved, it’s become easier and easier to make this information available to the public.

Not only that but state and federal requirements, common sets of definitions, all these things have helped improve the environment for sharing this information.

JJ: That said, what kind of feedback do you get that hints that you are on the right track?

MK: There’s one kind of transparency based on the consumer using the data, and since the site only launched in October, we’re still gathering feedback.What we do know from our focus groups and usability testing is that people are excited to learn that this information is available to them. We heard time and again that they would use this information to ask their health care provider about how they could stay safer and have a better experience the next time they needed health care services.

Beyond the benefit to consumers, there’s also the benefit transparency gives providers to learn from each other, and prevent harm from happening in the first place. We know from experience that transparency drives improvement. And the new site is adding new metrics and presenting the information in a way that makes performance differences more visible.

WA hospital quality

Comparison of hospital data for pneumonia / Source: wahospitalquality.org

We’ve gotten quite a bit of feedback from our member hospitals, who are big users of the site. For example, what is an incredibly common experience is that a hospital will be working on a specific measure, say, ventilator-associated pneumonia. They’ll use our site to see who is doing it better than they are, and they’ll call them and ask them.

The hospital might say, “We see you haven’t had ventilator-associated pneumonia in three months. What are you doing to make that happen?” And so they can share best practices and keep someone from ever getting an infection.


JJ: What kinds of things are roadblocks to transparency in hospital networks? How big a factor is trust when you are working with the competition?

MK: That question has an interesting story. Health care is a competitive industry, but when WSHA started its patient safety program in 2005, the board made a commitment to share information that would improve the health and safety of patients. That meant sharing data about how they were doing and sharing improvements that were working to improve care. When it comes to making care safer for patients hospitals weren’t going to hold out on each other as competitive advantage. There is an agreement that everyone should be able to get safe health care no matter where they seek care.

So while hospitals do want to create better value for their communities, and there’s a lot of public desire for a competitive health care marketplace, there’s also a long-standing commitment to share safety information with the public and with each other.

JJ: Do you find that spirit is captured even today?

MK: We could not be where we are today if that spirit had not actually gotten stronger over the years. Hospitals have been very engaged in the process of improving patient safety. It’s all member-driven. WSHA is a convener, but the members of our patient safety committee and our partner organizations are driving the work forward. We work with the Washington State Medical Association, CMS, the Department of Health, the Health Care Authority, specialty groups, nurses, insurers and many other organizations. There’s a lot of momentum there. This is also an area where competition is really a force for good, hospital leaders want to be the best, so they’re driven to make improvements.


WSHA represents community hospitals and health-related organizations / Source: wsha.org

JJ: So is Washington, as a state, unique in its collaboration when it comes to hospital networks?

MK: Yes, and I wouldn’t limit it to hospital networks or even health systems. Independent hospitals are also very involved in our patient safety program.

Small rural, critical access hospitals are very involved. Getting numbers that are meaningful for them is harder because they don’t see as many patients, but they are a big part of our transparency goals.

When I talk to colleagues in other states and describe how we run our patient safety program, and the degree to which we actively promote transparency of both quality and cost, the difference in what they’re facing is considerable.

JJ: What kinds of differences are other states facing?

MK: Even though our previous website was not very pretty, it was the practice of making the information available to the public that was valuable, and the fact that we started so many years ago that helped us get more comfortable with the process of sharing quality data and of using the data to compare hospitals. Investing to make the site more usable not just for members, who we already know use it, but the public to engage in to learn more about their care is a huge factor.

What we do know is that people want to know a little bit more about what quality means and how it gets measured and how to keep themselves healthy.

JJ: There’s a big focus on rural health in Washington. How does data transparency work with consumers who might not be as tech savvy?

Critical Access hospital yakima

Sunnyside Community Hospital, a Critical Access Hospital (CAH) in Yakima / Source: yakimavalleylive.com

MK: We do a lot with rural health and members who serve rural areas. But I think it’s a mistake to assume that those that are in a rural environment are not as tech savvy. For some, they need be even greater users of internet resources because it’s not as easy to shop a bunch of providers.

The nexus is that we did not leave out rural hospitals from the quality website. It would be easy to because Critical Access hospitals see much smaller cases and sometimes the data gets a little weird. You can imagine what a percent over time is when you see one or two patients a day, compared to a hospital that sees 20 or 30 types of those patients a day.

So some quality sites will just leave rural hospitals out completely. We wanted to include them as much as possible and help people to understand about the data that they are looking at. So we’re working to make it easier for people looking at quality data for rural hospitals to understand why they aren’t seeing the same kind of data in the same way. On the new site we tried to reflect this information and tell people why numbers weren’t included or, if an organization had what looks like a high rate of something because of the small number of cases, we note the actual number of infections in addition to the rate.

That is something we are going to continue to work on. Things that aren’t perfect for people looking at the data on their rural hospitals right now are going to improve over time.

JJ: What is on your radar for the future?

MK: That’s a big question. What we’re looking at right now is a redesign of our health care system. Without stopping providing health care in the old way, but also providing it in the new way. We need to find way to improve the quality of care and increase the access to care, and still get the care delivered in the right location at the right time.


Emergency room at Virginia Mason Medical Center/ Source: yelp.com

It’s the triple aim: Improve the experience of care, improve population health, and reduce the per-capita cost. And it’s going to take all of us: providers, insurers, regulators, employers and communities. But also all of us— if we want different results, we’re going to have to change our behaviors as patients and consumers.

Even if we all reach optimal health, we’re still going to need an ER every once in awhile, and lots of other kinds of acute care. The current payment system doesn’t pay doctors and hospitals to keep people healthy, it’s still based more on acute care and numbers of patients. How do you preserve access to those intense services, and yet decrease the use of them?

Those are the waters that I think everyone agrees that we’re navigating.

JJ: Thank you very much for your time, Mary Kay.

MK: Thanks, JJ.