More than a year in the making, The Seattle Times’ “Quantity of Care” investigation explores troubles inside an acclaimed neuroscience center at Swedish Health in Seattle. Investigative reporter Mike Baker, data journalist Justin Mayo, graphic artist Emily Eng and interactive developer Thomas Wilburn combined to produce a powerful series about some of the country’s most prominent brain and spine surgeons, and the high-volume approach to care that many insiders found troubling.
The impact of the project has been swift and sweeping. One week after publication of the initial stories, the state Department of Health launched an investigation. Within two weeks, Swedish’s CEO resigned. Within three weeks, a top neurosurgeon featured in the articles resigned. And a month after the first stories came out, the U.S. attorney’s office launched an investigation.
Swedish has vowed internal changes, such as new patient consent forms that are more transparent about surgical practices. Two other local medical institutions also updated their consent forms. The state Legislature, meanwhile, approved a law holding hospitals accountable for their nurse staffing levels.
The project relied, in part, on several large databases, including annual datasets purchased from the state Department of Health showing anonymous information on every inpatient hospital visit in the state. Mayo combined that database – built on eight relational tables – with a slice of a federal database that identifies millions of medical professionals.
Mayo and Baker spent weeks learning medical coding for procedures and diagnoses to explore aneurysm surgeries, strokes, accidental surgery cuts and more. Adding to the challenge was the national switch from ICD-9 to ICD-10 coding protocols, forcing the reporters to learn two distinct coding methods. In analyzing billing data, the reporters found a dramatic shift at the Swedish Neuroscience Institute, which had recruited a top surgeon with a troubled past and incentivized large surgical volumes.
The reporters also plumbed other datasets: Medicare spending data, Medicare data on procedure values, federal data on complications, California data on aneurysm cases, and Washington state’s death database. Working with sources, The Times also obtained internal Swedish data showing the start and stop times of thousands of surgeries. The new data, analyzed by Mayo and displayed by Eng and Wilburn, showed the extensive use of double-booked surgeries. The online presentation of that data included an interactive, showing how surgeons juggled their caseloads during one week.
To reach audiences, The Times experimented with an array of digital tools. The initial story featuring the case of Talia Goldenberg published exactly three years after she went in for surgery. In the days before publication, we launched a newsletter that distributed time-stamped vignettes about Talia’s life in the days before her surgery. Thousands of highly engaged subscribers joined that ongoing newsletter, which has provided a platform for sharing internal documents, behind-the-scenes insights and a callout for tips patients should consider before surgery.