Unaccountable: Our Q&A with author of provocative new book

January 12th, 2015

Marty Makary, MD, MPH, an associate professor of surgery and health policy at the Johns Hopkins Hospital in Baltimore, is the author of the recently published book "Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care."

We talked to him recently about health care associated infections (HAIs) and other patient safety issues raised in his provocative book.

“I talk about infections a fair bit and about the progress that has been made in measuring infections, and how increased measurement results in improvement in infection rates,” Makary tells Hospital Infection Control & Prevention. “When infection rates are available to the public, hospitals place more resources into the effort to prevent them.”

Our interview with Makary continues as follows:

HIC: The old recommendation to calculate and feedback surgeon-specific surgical site infection (SSI) rates seems to have fallen out of favor. Why isn’t that being done more?

Makary: “The problem with surgeon specific infection rates is that they are often not statistically valid because if you look at the case mix of an individual surgeon many times they have a broad range of operations that they do with high and low risk of infections. I believe that the best level to evaluate infection rates is at the hospital level. When the hospital infection rate is public the administration will scramble to tap their local wisdom, to talk to their infection control personnel and their doctors to find out how to fix the problem. The public disclosure of infection rates is what creates accountability at the hospital level, and accountability is what drives resources to be dedicated to fix the problem on a local level.”

Regarding SSIs, are many post-discharge infections still going undocumented for lack of follow-up? Historically, that has been a problem.

“It’s still an issue; we still lack standardized measures nationwide. For example, the American College of Surgeons (ACS) has a program called NSQIP -- the National Surgical Quality Improvement Program -- that has highly standardized independent definitions of what constitutes an infection. Yet only 500 hospitals in the United States participate in their measurement program. Historically, we have a problem with hospitals that do a poor job of measuring infections coming out looking good, but those that do a very good job of tracking down their infections come out looking bad. Without standardized definitions we end up punishing people that are doing a good job.”

For more of this inteview seen the November 2012 issue of Hospital Infection Control & Prevention