Is organizational transparency possible in healthcare? The very nature of healthcare includes private, personal information. Does this prevent healthcare organizations from having a culture of transparency? What are the benefits of being transparent and why don't more institutions strive for transparency?

Medicine is based on trust. Patients trust that a doctor is going to take care of them. Doctors trust that their organization will support them. In a healthy institution, you see trust reflected in every interaction. But no person or place is perfect. People make mistakes, and when that happens, trust is reduced and needs to be restored. Fostering trust is one of the major benefits of transparency. It is impossible to learn from a mistake without first acknowledging it. When there is an event, there is a choice to be made. The organization that acknowledges and addresses a mistake retains the community’s trust. Versus the organization that denies the problem and withholds, hides, or misrepresents information. On the inside, a culture of blame and shame breeds a toxic environment. On the outside, this behavior erodes the community's trust. Transparency is a conversation that banishes blame and cultivates constructive thought.

Transparency improves safety. In line with learning from mistakes, maintaining awareness of performance is the only way to learn and improve. As Peter Drucker said, "If you can't measure it, you can't improve it". This extends further in a healthcare organization. If you track outcomes and measure results but keep the numbers hidden from team members, they can not contribute to improvement. You are relying on the few that know to provide the solutions and they may not be the right people with the right knowledge. It is a substandard use of the team's abilities. When tracking is implemented and all team members are brought to bear, the best achievements can be reached.

Culture change is not easy. Moving from no or low transparency to full visibility requires a plan and time for adaptation. It requires buy-in from everyone in the organization and a leap of faith in each other. Increasing internal visibility in low-risk areas will give team members time to adjust and become advocates. A good place to start is increasing internal access to measures of performance and outcomes. When the organization has reached a good level of comfort with internal transparency, it will be ready to work on external visibility, eventually becoming a resilient culture that constructively incorporates all feedback.

Clearly, there is a benefit to healthcare in transparency, even though enacting and maintaining transparency is difficult. Egos must be checked at the door; none of us want to reveal our faults. But, intentionally acknowledging our faults leads to positive change. Ultimately it is conversation through all levels that will lead to long term success.