Cutting through the haze

There is a fog of confusion around hospital transparency and public report cards that needs to be lifted. I hope to clear up some of that confusion -- at least in relation to the 100 Top Hospitals scorecard compared with clinical process measures from the CMS' Hospital Compare project and from the Joint Commission on Accreditation of Healthcare Organizations. Solucient's 100 Top Hospitals: National Benchmark study is focused on broadly evaluating hospitalwide performance by calculating a composite score across a set of balanced organizational performance measures.

The Hospital Compare measures are designed to gauge very detailed disease- and operation-specific clinical processes. Major goals are to provide consumers and other audiences with usable information to compare hospital performance and to provide hospitals and physicians with national comparative information to improve basic treatment for those diseases and operations. While these two approaches to measuring hospital performance are very different, they are not unrelated. Our statistical analysis of hospitals with high scores on Hospital Compare process measures and high scores on the 100 Top Hospitals hospitalwide measures shows a highly significant correlation. Correlation is also significant between high scores on the Hospital Compare measures and a high rate of consistent improvement over five years on the 100 Top hospitalwide measures (data from Solucient's 100 Top Hospitals -- Performance Improvement Leaders). One theory for the highly significant correlation between high performance on the Hospital Compare measures and the 100 Top hospitalwide composite score is that hospitals focused on excellence across the organization are better aligned and therefore develop better processes to produce higher quality. The assumption is that if a hospital is well-managed and well-aligned, then the hospital will develop higher standards for basic clinical processes. In support of this argument, the facilities on the 100 Top Hospitals rankings, by definition, have better organizationwide performance in clinical outcomes, patient safety, efficiency, financial stability and growth. A second theory is that focus on excellence in clinical processes may be a key driver of development of an overall culture of performance improvement and higher hospitalwide performance. To determine whether hospitalwide improvement drives clinical processes or if it's the other way around, a critical element needs to be considered: the impact of leadership. Leaders set the priorities that drive hospitalwide improvement. At the 100 Top Hospitals program, we and our research partners hope to clear the fog regarding the role of leadership. Stay tuned. Jean Chenoweth is Solucient's senior vice president of performance improvement and the 100 Top Hospitals programs.