Advancing the Science of Medical Transparency · Good Culture. AHRQ National Avg. Rates of PE/DVT....

Advancing the Science of Medical Transparency

Marty Makary MD, MPHDepartment of Health Policy & Management

Johns Hopkins University

210,000 deaths

Causes of Death in the U.S.Causes of Death in the U.S.

Cotman

1. Heart disease: 597,6892. Cancer: 574,743

3. Chronic lower respiratory diseases: 138,080

Source: CDC

Cotman

Trip Advisor

Thank YouThank You

MartyMakary@gmail.com

Apple Store

Safety Attitudes Questionnaire (SAQ)Safety Attitudes Questionnaire (SAQ)

It is easy to speak up if I perceive a problem in the OR

I would feel comfortable having my own care here

Makary M, Sexton JB, Freischlag J et al. Patient Safety in Surgery. Ann Surg, 2006;243:628-32.

“I would feel safe being operated upon here as a patient”

0102030405060708090

100

Hospital (each bar = 1 Hospital)

% re

spon

dent

s rep

ortin

g go

od sa

fety

clim

ate OR Safety Climate by Hospital

Makary M, et al., Patient Safety in Surgery, Annals of Surgery, 2006

Introduction

6.1

9.3

0

1

2

3

4

5

6

7

8

9

10

Bayview

Poor Culture Good Culture

AHRQ National Avg.

Rates of PE/DVTEv

ents

per 1

000 d

ischa

rges

PostopPostopSepsisSepsis

PostopPostopBleedingBleedingS.S.I.S.S.I.

p<0.05p<0.05 p<0.05p<0.05 p>0.05p>0.05

Unpublished data

% A

gree

“It was difficult to speak up if I perceived a problem with patient care.”

Makary et al. Operating room briefings and wrong-site surgery. J Am Coll Surg 2007;204:236-43.

Nundy S, et al. Impact of Preoperative Briefings on Operating Room Delays Archives of Surgery, 2008143:1068-72.

“There was an unexpected delay related to the case.”