 It's a common buzzword right now, transparency. From Boeing to the recent oil spilloff the coast of California, we're seeing the value of transparency and it's ability to help us learn from mistakes. It's hard for companies and organizations to be transparent, but it's the moral and ethical thing for them to do. We respect transparency and the potential it has to keep all individuals safe. However, today we really want to talk about transparency in the healthcare setting, specifically how to enhance patient safety and the quality of care patients receive through transparency. There are four key issues that transparency needs to improve. The first one is there is a lack of open and honest communication. The second is the difficulty in quantifying the problem of unsafe care. The third is inadequate public access to safety data and finally the suppression of information that helps make care safer. First, a lack of open and honest communication affects transparency and when individuals do not feel psychologically safe, it is difficult to have these emotional and intense conversations. Psychological safety is being able to show and employ oneself without the fear of negative consequences of self-image, of status or career. And as a team, there's a shared belief that team members also need to feel accepted and respected after harm. Psychological safety is essential for providing safe care and when it's not present or upheld can lead to a lack of open and honest communication when harm occurs. One of the underlying causes for the lack of open and honest communication after harm is the punitive nature of healthcare in general. You see, healthcare workers may not feel safe or protected in reporting what we call near misses, things that don't reach a patient family or other serious safety events. They are often still very afraid of what is known as the shame and blame culture. And if they report these deficiencies that are supposed to help provide feedback into the system to improve it, to learn and to make it better. They also worry that reporting to patient safety events will lead to unfair punishment of other healthcare workers, in particular their colleagues that are involved in the event. This lack of open, honest communication between workers in their own healthcare system is not a culture of learning. And if the workers can't talk to themselves then how do we expect providers to have those open and honest conversations with patients and families after harm events? What we need to do is create a system where patient safety and the quality of care are always on the forefront. The second issue around transparency is the difficulty in quantifying the problem. You see, no one is able to quantify the true number of preventable medical errors in the United States. The current estimate says that anywhere from 200 to 440,000 patients a year die due to unsafe care. This is mainly due to the lack of transparency and the lack of standardized measures to collect data around preventable harm and death. This impacts patient safety and quality improvement because we don't have access to reliable data. The third issue resides in inadequate public access to safety data. Hospital and healthcare organization safety data is not transparently available for the public to view. This includes current and future patients seeking care as well as potential employees of facilities who might be looking at safety data before joining and signing a contract to work in that healthcare organization. Simply put, we do not have access to all the appropriate information to help us decide where we should seek safe and reliable care. The current agencies that collect and report safety data are not eliciting the outcomes that they were built to generate. And finally, information is suppressed. We are demanding a more transparent healthcare system, but the current legal and regulatory environment, those agencies surrounding the healthcare system enable the deliberate suppression of serious harm event information, which precludes the ability to learn from these events. The systems directly contradict one another making it difficult to have meaningful progress. For instance, patient safety organizations, often known as PSOs in the US, suppress information. An example of this is there are over 90 PSOs in the United States, and yet only three of them share their information. This isn't good learning. Other areas of concern are non-disclosure agreements, NDAs, forced arbitration agreements, and other gag clauses that impede the sharing of information around medical errors and preventable harm. And these need to be addressed, addressed head on as well. If you have any ideas of how we can address these issues, please leave a comment below and subscribe for more patient safety content. We'll be posting four follow-up videos to dive deeper into each of these four issues soon. Make sure you are subscribed to our channel so that you'll be notified when we post them.