Former U.S. Treasury Secretary Paul O'Neill is a member of the Lucian Leape Institute, and he can be as blunt as Leape himself when it comes to patient safety.

"Organizations are habitually excellent or they're not," he said at last week's National Patient Safety Foundation Congress near Washington, D.C.

O'Neill said hospitals ought to post rates of nosocomial infections, patient falls, medication errors and employee injuries on the Internet for all to see, and he thinks they ought to do it every day. "Let's bring some energy to this," he said.

Institute member Gary S. Kaplan, M.D., CEO of Virginia Mason Medical Center in Seattle, agrees that transparency is key. Improving safety "is really about change management, making our organizations better. How can we do this unless we have an environment of transparency?"

Besides, Kaplan asked, "what could be a higher plain to be on in health care than truth telling? We haven't been doing that very well."

Hospitals really don't have a choice. The pressure is on from CMS and others to publicly report everything from pricing to readmission rates to patient satisfaction scores. Medicare reimbursements and eventually private insurance payments will depend on it. "The U.S. is in the process of creating a health care marketplace in which we will compete on value, quality and cost," Kaplan said.  "We must have transparency on all those things."

Moreover, the information reported needs to be a lot more up to date, said Carolyn Clancy, director of the Agency for Healthcare Research and Quality. "We're not so good at timely transparency," she said. "We must get to a place where we get data in something like real time."

Bemoaned Leape, the chair of his namesake institute, "It's a measure of how far we have to go that transparency is still so threatening to so many organizations."

Are you concerned about the pressure for greater transparency in service costs, error rates and nearly every other aspect of your hospital's operations? Should hospitals be required to post that information on the Internet? Let me know at

Don't worry, as always I won't identify you or your hospital when I report back on responses to these questions.