Reznet

Transparency as a Tool for Reform

By Mark Trahant

Paul Levy’s Running A Hospital "is a blog started by a CEO of a large Boston hospital to share thoughts about hospitals, medicine, and health care issues." The postings started as a lark. But when the president and CEO of Beth Israel Deaconess Medical Center writes openly that sends a message that filters down throughout the system. Other hospital professionals started blogs and more hospital data was posted in real time making transparency a core value.

People already use the Web to search out medical information of all kinds (several studies show it second only to Porn for Internet searches). Health organizations have a natural, built in audience of people wanting to know what’s going on.

So how do health professionals by and large manage this interest? "Effective immediately, the Hospital is blocking access to social networking sites including Facebook, MySpace, and Twitter from all Hospital computers," says an internal memo from another system as blogged by Levy. "The Executive Team will be working in the coming months to ensure that we have written policies in place that articulate the appropriate use of social networking sites while on duty at the Hospital. Once these written policies are in place, we have educated all employees about expectations and disciplinary action associated with violating the policies."

The message is clear. Information is scary. Adults cannot be trusted.

Levy’s response: "Any form of communication (even conversations in the elevator!) can violate important privacy rules, but limiting people’s access to social media in the workplace will mainly inhibit the growth of community and discourage useful information sharing. It also creates a generational gap, in that Facebook, in particular, is often the medium of choice for people of a certain age. I often get many useful suggestions from staff in their 20’s and 30’s who tend not to use email. Finally, consider the cost of building and using tools that attempt to "track utilization and monitor content." Not worth the effort, I say."

It’s not worth the effort – and it’s counterproductive. Transparency is an added value to any healthcare organization. Being open – even reporting your own mistakes or poor execution – is an essential strategy for building a stronger network.

Levy writes a key part of any leader’s job is … "to create an environment in which people are so comfortable with their role in the organization, and are given the right tools for doing their job, that they hold themselves accountable. After all, most people want to do well in their job and want to do good in fulfilling the values of the enterprise. Why not trust in their inherent desire to be successful personally and collectively?"

That also happens to be the policy of the Obama administration. A December 8 memo from the Office on Management and Budget called for the creation of "a culture of open government." Agencies across government, including the Indian Health Service, are in the process of coming up with plans to make execute that idea. But this is new for government. The idea of every agency staffing a Twitter or Facebook account is still a huge debate. Federal employees often have to leave the building and go to a coffee shop if they want to update even an official social media site. (If you want to see a government agency with a smart social media plan, check out aids.gov)

Dr. Yvette Roubideaux’s director’s blog has the potential to engage the American Indian public the way Levy does with his blog. But it requires a different way of thinking – something that’s rare in government. For example when I talk to Indian Health Service employees for this project they must get permission from either their area office or headquarters before engaging with the media (let alone social media).

Imagine what the Indian Health Service could bring to its patients by embracing openness. Real time information, ranging from data to patient feedback, can help any organization improve results. Quickly. What would happen if every clinic, hospital or any other facility in the Indian health system had its own social media page, complete with patient feedback? What if patients were encouraged to access a computer terminal in the waiting room and post comments on their way in and out of a facility?

Real time information is not scary. It’s a tool for reform.

Mark Trahant is the former editor of the editorial page for the Seattle Post-Intelligencer. He was recently named a Kaiser Media Fellow and will spend the next year examining the Indian Health Service and its relevance to the national health reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes.

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