Another hospital report card showed up last week adding to the pile of ratings already available. A few years ago there were more than one hundred offered by various for-profit and not-for-profit businesses and government agencies. The newest one is the Hospital Safety Score report card from the Leapfrog Group, an organization led by employers that buy employee health insurance and aims to improve the safety of U.S. hospitals. Leapfrog hopes to get the public's attention by assigning just a single letter grade, from A to F, based on twenty-six different measurements of hospital performance, such as entering physician orders into a computer to avoid handwriting errors.
Hospital report cards have been around for awhile now, but the public has never really used them in selecting a hospital, says Jordan Rau, a writer for Kaiser Health News who reports on hospital quality. A lot of things that put you in the hospital are immediate problems that don't lend themselves to comparison shopping, and consumers are directed to hospitals based on their doctors' preferences, their insurance coverage, geographic convenience or their general sense of a hospital's reputation.' It's the reputation thing that bothers hospitals, many of which have spent gobs of money polishing their image through slick PR activities designed to make sure the public thinks well of them.
So, naturally, many hospitals have never liked rating schemes very much and have usually found fault in them, especially when their facility didn't fare well. Some of the gold-plated hospitals in the country did not get good marks from Leapfrog.' ' New York-Presbyterian in New York City and the Cleveland Clinic both got a C.'' Leapfrog gave UCLA Ronald Reagan in Los Angeles the mark of 'Grade Pending,' which Rau points out is 'Leapfrog's euphemism for below a C. Predictably the hospitals squealed.' The chief quality officer at the Cleveland Clinic, Dr. Michael Henderson, complained that the data Leapfrog used was old.' He said the questions the public needs to ask are: Are you working on this? Are you getting better?''
Just as predictably, health policy researchers argue the new Leapfrog ratings are a step forward and will get better over time. As it so happens, I found myself in England a few days ago at a workshop for health journalists along with one of that country's experts on hospital safety and quality, Sue Lister.' For many years, Sue taught health care improvement at Coventry University and is an emeritus professor of quality and safety in health care at the University of Massachusetts and a teaching faculty member at the Institute for Innovation and Improvement, a part of Britain's National Health Service.
Eager to bring a new voice to the American debate, I asked Lister about hospital ratings. 'Just because we can rate something, doesn't mean it improves quality," Lister told me.' "My main fear is, with this sort of measurement, the things being measured become an inappropriate target which alters the focus of how we work.' Monitoring doesn't change behavior'you don't increase milk yield by weighing the cow'and it is a retrospective measure.' Furthermore, Sue questions reducing measurement to a single grade.' 'I do not see how A to F is logical for something you do or you don't do,' she explained.' For example, giving an antibiotic to a patient one hour before surgery is a good thing, but, she asks, 'It's either administered, or it isn't.' If grading is about how often something is done correctly, it doesn't actually help.'' If the antibiotic is given 70 percent of the time, it doesn't help the 30 percent who did not get it, exposing them to possible post-surgical infections.
For them,' she pointed out, 'It was a 100 percent failure.' Then, too, ratings aren't very helpful if you don't live in a place where the good hospitals are as determined by the rater.' Leapfrog found that Massachusetts, Maine and Vermont were the only states where half or more of the hospitals received an 'A.'' But what if you live in South Dakota, Alabama or Arkansas where at least two-thirds of hospitals got a 'C' or lower?' You probably don't have much opportunity to go to a hospital with a higher grade. This all circles back to some tough questions for which the answers are not clear:' Just what should a consumer make of the Leapfrog ratings? ' When our local hospital gets an 'F', what can we do about it?'
Should we 'talk to our doctor at that hospital and urge them to improve their safety protocols' as Leapfrog suggests we do?' Is it helpful or realistic to provide people with numerous checklists to help us 'Prepare for your Hospital Stay'?' The Kaiser Health News reporter, Jordan Rau, reminded us that, 'a lot of things that put you in the hospital are immediate problems'. Don't the experts behind these hospital ratings understand that too?