Health system transparency varies greatly from country-to-country, according to a study from KPMG International.
Through the looking glass: a practical path to improving healthcare through transparency places four Nordic nations – Denmark, Finland, Sweden and Norway – at the top of the transparency rankings, with Australia, Netherlands, New Zealand, UK, Portugal and Singapore among the second tier, and China and India propping up the index. KPMG rated nations’ healthcare systems on the availability of data across six dimensions of transparency, including quality care, financial performance and governance.
Even the high performers lack consistency across all forms of transparency, with much room for improvement. “These 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. “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, 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.”
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,” said Marc Scher, Chair of KPMG’s healthcare transparency study and a partner with KPMG in the US. “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 analyzing numbers that are never really used. “Some hospitals we looked at are delivering as many as a thousand performance indicators,” said Scher. “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.”
Transparency may not have delivered on its promise, but that doesn’t mean it’s going away. As the report emphasizes, 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 realize 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.”
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Through the looking glass: a practical path to improving healthcare through transparency is a global study that examines how health systems are approaching transparency, and what they can do to maximize the benefits from this powerful, positive change agent. The study also explores what makes a health system transparent, and imagines an optimum future for transparency – and how to achieve this. The study is the result of 25 interviews with a variety of global healthcare experts, 16 global case studies from countries like Australia, Denmark, Germany, the Netherlands, UK and US, an extensive literature review, plus a transparency scorecard completed by leaders of KPMG’s health practices in 32 countries, which informs an index of performance across six key dimensions of transparency (see full Index results).
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