What if you don’t make the grade?
Some lists resemble popularity contests
What should you do if a patient asks why your hospital is not on the "Best of" list she saw in last night’s paper or the current news magazine? Consultants’ opinions vary on this. You might know your hospital wasn’t included on a given list because the list is flawed or unreasonable. Should you challenge the validity of the list’s scoring criteria? Should you dispute its accuracy?
No, says Robert Luttman, a health care management consultant in Medfield, MA. "Even if a list is flawed, if the public takes it seriously, you have to take it seriously.The public won’t and shouldn’t pay attention to wrangling over numbers and data and calculations. The impact of what they read or heard is a part of the public consciousness. It’s too late to do anything about it."
Michelle Pelling, MBA, RN, president of the PROPELL group in Portland, OR, does not completely agree. "If you can see that one particular list places an inordinate emphasis on length of stay, for example, you can explain that its criteria didn’t include service and quality of care. If it had, your facility would be right up there. Respond with that type of information." (See article on criticism of US News & World Report’s "America’s Best Hospitals" ranking, above.)
Another, perhaps more constructive tack is to take a proactive stance. "Decide what list you want to make," says Pelling, "and use those measures to improve your own performance."
Luttman says "good" hospitals look beyond endorsement by the Joint Commission on Accreditation of Healthcare Organizations in their management and quality improvement efforts. They establish their own internal standards for quality of care.
"You have to shoot for excellence," he says, "not just Joint Commission compliance. JCAHO accreditation no longer carries a marketing advantage. Upward of 90% of hospitals are accredited, and no one gets excited about that anymore. It’s a given if you’re in business. In this quality-driven market, it doesn’t mean you can compete."
Other criteria, like those put forth by the Malcolm Baldrige National Quality Award, should be examined, Luttman advises. A part of the National Institute of Standards and Technology in Gaithersburg, MD, Baldrige lays out a comprehensive set of criteria for achieving quality management. Among them are leadership, strategic planning, process management, and patient satisfaction.
Who’s doing the counting, and why
Being on a top-100 list can, without a doubt, be a good marketing tool, but statistics can work for or against you. Many fine facilities are often not included on top-hospital lists. Reasons vary, but the first questions you should ask are "Who put the list together?" and "On what basis?"
"You have to look at where the lists are coming from to make sense of them," Luttman says. "What are the criteria? What is the scoring system?" (See related article on HCIA-Mercer’s list, above.)
"I’m skeptical of most lists. If you ask a doctor his opinion of a hospital, and then ask a hospital administrator the same question, they will have different opinions," says Sharon Baschon, RN, a UM consultant in Durham, NC. "Most top-hospital lists are based on subjective parameters. Your own state report cards use objective, severity-adjusted patient data and specific DRGs. You don’t see that in the top-100 lists."
Small rural hospitals with less severe populations have been known to get on lists that large urban hospitals miss. The smaller facilities don’t handle the more complex cases those patients are sent to the larger tertiary facilities and their mortality rates are low.
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