Massachusetts hospital executives flicked on their radios and opened their newspapers with fear and trembling and not just because it was Friday the 13th.
The media had published the results of a survey of patients' experiences at 58 Massachusetts hospitals. The Picker Institute conducted the survey for the Massachusetts Health Quality Partnership, a consortium of hospitals, insurers, doctors and employers (Oct. 19, p. 43).
It is the first time virtually all the hospitals in a state have agreed to be surveyed using the same questionnaire and jointly released the results. The questions addressed patients' experiences in three areas: medical service, surgery and maternity care.
Hospitals with many good scores included Winchester (Mass.) Medical Center and Milton (Mass.) Hospital. Maternity patients at Deaconess Waltham (Mass.) Hospital are very happy. Four hospitals-including Massachusetts General, Boston-had no scores that were either significantly higher or significantly lower than the norm in 21 ratings.
"Every hospital in the state approached this with some trepidation," said John O'Brien, chief executive officer of Cambridge Health Alliance. "Maybe some of us who didn't score so well should have approached it with more trepidation than others," he added with a laugh.
Most Massachusetts newspapers and many of the state's radio and television stations covered the report extensively.
Hospital leaders contacted by Modern Healthcare said they were pleased. "What I've heard, people have felt positive about the media reaction to the release," said James Mongan, M.D., president of Massachusetts General. "People's concern was that the media might jump to the obvious: `Let's put the 10 best and 10 worst on the front page.' There's a lot more in there than some ephemeral calculation of the top 10 and the bottom 10."
David Veroff, Picker's director of client services, called the coverage "accurate, balanced and reasonable."
"There was very little of what you fear-inappropriate slamming of specific institutions," said Ira Wilson, M.D., a quality expert at New England Medical Center, Boston.
Mark Tolosky, CEO of Baystate Medical Center in Springfield, which had the most below-average ratings, said the coverage was responsible and fair.
"You wince" at poor scores, said O'Brien, whose hospital had the second-most lowball ratings. But hospitals shouldn't make excuses or back out, he added. O'Brien said he would participate again.
Picker, the Massachusetts Hospital Association and other interested parties tried to prevent the project from turning into a dumbed-down list story. The fact that the tone and message of the published stories were so consistent testifies to their success.
The consortium held two in-depth briefings for reporters on Nov. 10, one in Boston and one in Springfield. Reporters who wanted survey material were required to attend. All stories were embargoed until the morning of Nov. 13, so that reporters had time to study the material, talk with local hospital executives and prepare graphic presentations.
Newspapers emphasized several points:
* Hospitals in Massachusetts collectively score higher than the national average in patient satisfaction among Picker clients.
* This was the first time almost all hospitals in a state had agreed to jointly release their data.
* The relative positions of the hospitals are less important than the fact that all hospitals are striving to improve the patients' experiences.
* This is a very complicated business, and the information should not be oversimplified.
Channel 4 in Boston even told its viewers the report was too convoluted to explain on television and directed them to newspapers.
The Boston Globe delivered a cogent and nuanced analysis. It devised a matrix of all 1,218 scores-seven questions in three areas at 58 hospitals-which even Picker officials were using the next week.
A ground rule that helped the project take off was that hospitals cannot use the data to advertise or promote themselves or to bash a competitor. Hospitals also agreed not to publicly challenge the methodology, a favorite escape route from unpleasant results.
Wilson said the media coverage was generally "quite solid" but missed some subtleties. "One of the striking things is the lack of variability," Wilson said. "There were only a couple outliers in each direction. The vast majority were toward the middle. In many ways that's a good thing."
That's probably because Massachusetts is overdoctored and overserved. In other states, Wilson said, there would be much more variation.
Such surveys have been done in other states, but the hospitals have not agreed to let Picker release the results.
As for New England Medical Center, Wilson said, "We got zero publicity about this. We were right in the middle, and nobody mentioned us. That's not a positive or a negative. That's fine with us."