Fines Do Not Matter, Transparency Does

I don't normally write about patient safety or risk management issues directly, but the news in today's Boston Globe about a potential whistle-blower lawsuit by a fired Jordan Hospital nurse grabbed my attention. I actually think this story is as much or more about transparency than anything else. Fortunately, in this instance, it appears both mother and newborn twins (born premature) are doing well. I choose to believe this is due to a combination of factors including the talent and care provided by the receiving hospital staff (South Shore Hospital), the mother and her infants, and perhaps even grace.


The Infractions in question relate to a federal law that prohibits hospitals from transferring patients without first making sure they are stable and have been examined by a physician. The plaintiff has been a nurse at Jordan for 38 years, most recently as director of occupational health and risk management - so she is presumably intimately aware of federal and state laws attendant to transfers as well as reporting violations to proper authorities when they occur. Nurse O'Connor accuses Jordan Hospital of terminating her employment because she reported a violation of the aforementioned federal law.


What is most concerning about this alleged incident (now that mother and children have recovered) is the focus on fines (of the hospital) and punishment (of the hospital and the nurse, assuming it contributed to her termination) rather than on transparency. The protections afforded to whistle-blowers stand as an important example of the great strides the healthcare industry has made over the last decade toward the issue of transparency. Public reporting of healthcare costs, outcomes and quality improvement by providers (including hospital leadership, example Paul Levy's popular blog), payers (including CMS) and vendors (including WebMD) alike will continue contributing to this movement. An environment that celebrates and encourages transparency will ultimately have a far greater impact on quality and safety than fines and punishment.