During my residency at an academic medical institution back in the late 80’s we began using e-mail to communicate with many patients who were also employees. We still had paper charts and frequently printed out and place in the paper chart the e-mail exchanges so they could become part of the permanent record. I began asking the patients to look through the charts and sign their contributions. Funny thing happened; they began finding documents of other patients misfiled in their own charts!
It didn’t take too long before a few other physicians were doing the same thing. We started noticing the notes of other physician contributors to these charts were much more concise, clear and the hand-writing improved.
Could it be because everyone who contributed to those charts knew those charts would be audited by the people who cared most, the patients?
Later on when I had the chance to use an Electronic Medical Record that enabled any user to see who else had looked at the chart I began sharing this feature with patients. They immediately liked this and would spend some time looking through the list. When asked they were not too concerned about all of the people they didn’t know who accessed the chart but were angry and disappointed the physician whom they saw previously had not bothered to access the chart! When these physicians were later confronted they suddenly had a change of heart and began to use the Electronic Medical Record.
Don’t have any evidence other than these anecdotal recollections but I suspect that we could go a long way towards improving the quality of healthcare if we turned the medical record, whether electronic or not, on its head and thought of the patient as the primary owner/user of the record and physicians as guest contributors. We would assure 100% auditing and a lot more care would be taken to make sure the right things were documented and possibly the right care provided.
In short, I believe the solution to many quality issues in medicine and business can be achieved through greater transparency. I’m pretty sure that if all the shareholders had access to all of the company documents, meeting minutes and policies there would never be an Enron or similar disasters.