Once again, Thomson 100 Top Hospitals: National Benchmarks for Success winners show meaningful differences vs. peers in research performed for Modern Healthcare
’s annual 100 Top Hospitals supplement. This time the research shows that the 100 Top Hospitals have significantly widened the gap vs. peers by raising patient safety to a whole new level nationally.
The 100 Top Hospitals balanced scorecard measures performance of U.S. hospitals with a composite of scores in clinical outcomes, evidence-based medicine, patient safety, clinical and operational efficiency, financial stability and, later this year, patient perception of care.
In addition, the 100 Top Hospitals have once again shown that they act more quickly to address new challenges. The 100 Top Hospitals are better positioned than peers to limit losses this fall when Medicare curtails payment for hospital-acquired conditions.
While those on the 100 Top Hospitals list from Thomson Reuters Corp.’s healthcare business, formerly known as Solucient, are not best at everything, they continue to demonstrate higher performance where it counts. These hospitals are early adopters of practices that make simultaneous business and clinical sense, and they find ways to succeed rather than complain about the barriers—a classic characteristic of top-performing organizations identified by Jim Collins in Good to Great
. We have long known that the unanimity of the board, executive and medical staff leadership on organizational goals and strategies is a critical factor in achievement of excellence. We also know that the hospital leadership triumvirate does not lose sight of their responsibility to manage the whole organization and targets excellence across the organization—not in just one area.
The Midwest now is home to 47% of the 100 Top Hospitals national winners as well as the highest concentration of hospitals performing in the top two quintiles on the 100 Top Hospitals balanced scorecard, a level of achievement that was wrenched in 2004 from the Northeast and the South. Similarly, Midwestern states also show high hospital performance on the Agency for Healthcare Research and Quality’s state report card vs. states in other regions. So what did the leaders of Midwest hospitals do that resulted in such high regional improvement in organizational strength and high clinical quality?
One possibility is that in the Midwest, collaboration was extended beyond the walls of the hospital to employers, competitors and even payers. From 2000-03, while the Northeast and the South were the centers of top performance, Midwestern chief executive officers were making major headlines by very publicly starting collaboratives to increase transparency and high performance. The very high profile Wisconsin Collaborative for Healthcare Quality involved collaboration with competitors and employers. The Michigan Health & Hospital Association’s Keystone Center for Patient Safety & Quality involved competitors and Blue Cross and Blue Shield of Michigan. Some hospitals went even further. Genesys Regional Medical Center in Grand Blanc, Mich., and General Motors Corp. shared cost/quality data to make rate negotiations clearer and more rational, and added long-term value for GM employees and the whole community. Similar transparency and collaboration was successfully initiated in Ohio in 1999.
The operative words are “leadership commitment” and “collaboration.” Eleven of 12 Midwestern states performed in the top two quintiles of performance in both the 2007 and 2006 studies. While we cannot prove it with hard data yet, hospital leaders’ commitment to collaborate with employers, competitors and payers was a courageous step that raised the stakes in achieving higher performance. Collaboration with employers, competitors and payers on measurement and transparency created a level playing field for all, and that changed the nature of the value discussion. While competition and contentious provider/payer negotiations are still alive and well in the Midwest, collaboration of providers, employers and payers may be a significant reason why the Midwest was able to raise the performance bar so high.
But keep an eye on the West! Nearly half of the states in the Western region performed in the top two quintiles in our current study. I don’t know what Western hospital leaders are up to, but the West may be regaining its benchmark leadership, which it held from 1993 through 1996 when the 100 Top Hospitals study was first published. It may not be an accident that the 2007 Malcolm Baldrige award winners are located in Janesville, Wis., and San Diego, Calif.
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