One of the themes presented in this Policy Blog over the last year is that consumers should be careful about uncritical acceptance of unsupported promotional claims of quality by hospitals and other medical providers. After all, how can every hospital be “the best?” As in Lake Woebegone, at least some hospitals have to be average, and unfortunately, some even less than average when compared to their peers.
The Leapfrog Group is one of the very most respected organizations currently measuring and publicizing the safety and quality of care in hospitals. They use publicly available data and information provided voluntary by the hospitals themselves. Earlier this week, that organization made available their Hospital Safety Score derived from 26 different elements. I have not personally seen a more comprehensive panel of items rigorously assessed for this purpose. It includes, but is broader than the “Hospital Compare” scoring system published by Medicare. I would certainly have more confidence in these Hospital Safety Scores than any claims about quality or safety made by the hospitals themselves. In Leapfrog’s words, “The Hospital Safety Score is an A, B, C, D, or F letter grade reflecting how safe hospitals are for patients.”
Here are some of the facts that jumped out at me.
Louisville not so good!
Based on the extensive panel of items measured, the 49 Kentucky Hospitals received scores as follows: ‘A’s- 10, ‘B’s- 12, and ‘C’s- 25. Both state University Hospitals received an initial score of either a D or an F. All the (other) hospitals in Louisville received a score of only C. Compare the hospitals of Louisville to the hospitals of deep Appalachia which earned 4 ‘A’s, 3 ‘B’s, and one ‘C’. To my eye, it seemed that the larger the hospital and the larger the city, the worse the safety score. These rankings seem to fly in the face of accepted, or at least self-proclaimed wisdom.
There is a tremendous amount of additional information underlying these safety scores that might help us better understand their robustness and usefulness to us consumers. I was allowed to reprint the Kentucky scores and map with the permission of the Leapfrog group. I intend to dig into the supporting data more deeply to more fully understand the process and to try to explain the results. In the meantime, I suggest the following.
1. Start informing yourself. The items measured and discussed by the Safety Scores are becoming the standard panel and vocabulary of hospital quality and safety. We will be presented with these concepts in the future much more often. That is a good thing! We deserve more than just financial transparency and accountability from our healthcare system. It is our job collectively to demand that our hospitals do a better job, or at least explain why they disagree with those who are doing the analysis. We are also obligated to make sure such ratings are reliable.
2. I will begin here myself. All of you hospitals in Louisville that I might have to use personally had only average or worse safety scores. Why is that? Do you disagree? What are you doing about it? Show me how you are getting better. Please do not make any more claims about the excellence of the care that you provide until you can explain why presumably impartial judges rated the safety of your institutions as less even than good.
3. To the University of Louisville I can only repeat my earlier requests. The quality and safety of the medical care you provide as measured here and by others is poor as best. This is unacceptable. How many more outside examinations do you need before you get the message? The most important priority of your School of Medicine and your other health professional schools is to provide the highest quality medical care to the patients you serve. You cannot even begin to provide high quality medical education unless you succeed in fulfilling this most important responsibility first. Sponsoring research is a luxury to be enjoyed only when you get medicine and education right. Putting major efforts into your commercial research enterprise while running a hospital that your own faculty refuses to use in my mind constitutes abandonment of your duty to the Commonwealth. I am holding you responsible. Our community and governmental leaders should too.
Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
June 11, 2012, [edited June 12}