Hi, I'm Matt Austin, I'm a faculty member in the Armstrong Institute for Patient Safety and Quality. I'm joined today by Renee Demski, who's Vice President for Quality and Safety for the Johns Hopkins Hospital, the Johns Hopkins Health System, and the Armstrong Institute for Patient Safety and Quality. And in her role as vice president, she is responsible for the quality and safety measures that are reported for both Johns Hopkins Hospital and the Johns Hopkins Health System. Renee, thanks so much for taking some time to talk to me about quality and safety reporting. My pleasure, Matt. What do you see as some of the biggest challenges with the way the quality and safety that are currently reported? The challenges are improving over time, which I think is the good news. The challenges that remain are there is often a delay in the data. So, when you're looking at using data to improve quality as real time as you can get is most important to take action and demonstrate results. And so, I would say that delay is one. Even though there is much more synchronization across the external agencies, we still have a challenge with differences in definitions. So you have multiple measures or measures and multiple programs. And sometimes the inclusions exclusions are different. So, your performance may look great on one and not so good on another. So even though they're trying to do synchronization in that way more nationally and they've made some improvements, we still have some of those challenges as well. I think the third is we really support transparency for patients, but I still believe the public reporting is not too easy from a patient perspective to understand and really figure out what it means, the end result. So, how do you see the opportunities to make them better? I mean, if you could change public reporting, what change would you make? I would definitely try to have some consistency across the measures as opposed to, because you don't want to measure to the test and you're really talking about time and resources. And from my perspective, we really want to focus on the performance piece and not all the nuances with the measurement. So, I think standardization of the measures would be helpful. Also, transparency from the external agencies, there's still some part of the methodology that we call black box. And if we have a mutual goal to improve patient outcomes, we shouldn't have to figure out what part of the methodology or what part of it is really performance improvement related to improving patient care. So I would say if our goal is transparency for patients, we should all have transparency and move in the right direction to improve care for everyone. Okay. Do you see in your rule that public reporting has actually been a catalyst for improvement within the health system or is it really just sort of an external mandate that just is placed upon you? It's definitely raised quality and safety, I would say that nationally. We use a phrase here in the system that we want quality to be as robust as finance. And so when public reporting came into play and even though we're focusing on public reporting but then aligning it with pay for performance where you have patient outcomes and financial and reputational components all in one, it's really elevated quality and safety to be a top priority. And I think that's across the country and not just here, so that definitely has had some benefits in spite of its challenges. And if you could say one thing to staff here at the hospital or in the health system about public reporting, what would you want them to know? I wouldn't want to share with them that it really is about improving patient care and outcomes. First and foremost, that we really need to make sure that whether it's publicly reported or aligned with pay for performance, we have a shared goal. The second thing is there are so many measures now from external influence by external agencies that I would suggest that even though we monitor them, that they really focus on those that we need to improve performance and not be overwhelmed by the number. And if there's one thing you wanted patients to know about public reporting, what would that be? Matt, great question. I would want the patients to know that we totally support transparency, that it's really important that we provide data to the patient to help them make the right choice for the provider they're seeking care from or even the health care facility. The second piece of that, though, is public reported data is not sophisticated enough to use that information alone. So, I would encourage patients to use multiple data points, the publicly reported data, referrals from physicians and their primary care, as well as when they go to seek care from the provider, that they ask questions, like how many procedures have you done? What's your infection rate? And we have a lot more to do to help educate patients, to get to that point, but I would offer that, that would be the best approach. Well, thanks so much for sharing your thoughts and experience with public reporting and we very much appreciate it. Thanks, Matt. I appreciate the time. Thank you.
