The Leapfrog Groups second annual ranking of top hospitals struck the wrong chord among some hospital executives, who say the employer group is good at pointing fingers, but not at helping actual performance.
Leapfrog Group last week released the results of its annual survey and named 41 hospitals to its 2007 list of top quality and safety performers. Those 41 hospitals33 adult facilities and eight childrens hospitalsfully met Leapfrogs standards in intensive-care physician staffing, safe-practices scoring, and in either two or more of the eight evidence-based hospital referral areas or in computerized physician order entry plus one of the eight referral areas. The results are based on 1,285 hospitals that responded by Aug. 31 to the second annual survey. The report follows the Sept. 10 release of a Leapfrog report highlighting hospitals poor infection-control methods (Sept. 17, p. 6).
Although ranking hospitals lauded Leapfrogs initiatives, others in the industry found the list lacking. Leapfrog may set many rigorous standards, but it doesnt follow through on how to implement them, said Vi Naylor, executive vice president of the Georgia Hospital Association.
Yes, they are out there pushing leaps, theres no question about it, (but) they really dont do anything to help hospitals get healthcare right, she said.
Most agree that those are good standards on which to focus, but Leapfrog refuses to consider data submissions that dont exactly match their specifications, Naylor said. The GHA compiles data on its hospitals statewide based on CMS and Joint Commission standards, and works with facilities to implement evidence-based, standardized patient-safety and quality initiatives that reduce results variation.
Naylor said she has offered to work with Leapfrog in determining measurements and submitting data for Georgia hospitals, but they wanted it their way, which has kind of been their general response.
Jeff Barber, president and CEO of Owensboro (Ky.). Medical Health System, said he agrees that evidence-based measures are key to quality and safety initiatives, but Leapfrogs methodology is confusing. Quality measurement groups need to standardize their measurements, he said. The 345-bed hospital did not participate in the survey.
Barber said his hospital is active in the Institute for Healthcare Improvements quality and safety campaign and has focused on improving these initiatives in its facility for the past four years. We feel weve saved lives, he said.
In addition, change will be driven more by top-down leadership than the efforts of outside groups, he said.
Nevertheless, some healthcare executives, particularly those cited as leaders, favor Leapfrogs approach. Leapfrogs rigorous standards and measurement system is exactly what a patient needs when trying to find a hospital with the highest quality and safety performance, said Elliot Sussman, president and chief executive officer of 669-bed Lehigh Valley Hospital, Allentown, Pa.
In terms of following the standards, the group has established, there is hard and fast evidence that it does make a difference, said Sussman, whose hospital was named one of the top 41 by Leapfrog.
The employer group praised all the hospitals that responded to the survey for complying at least in part with its four leaps, but advocated even greater strides in implementing quality and safety practices. Only 10% of respondents have fully implemented CPOE, a small increase from 2.5% in 2002, according to the Leapfrog results. In addition, 29% of respondents with an ICU have hired intensivists, which the employer-based group estimates saves 20,000 lives a year. The number could be higher than 54,000 a year if all urban hospitals with ICUs had intensivists, said Suzanne Delbanco, Leapfrogs CEO, during a news conference.
The drive to improve safety and quality of care must start in hospitals and be encouraged and reinforced by all levels of leadership, others agreed. Early on we created a culture where we told on ourselves, said Thomas Schmidt, chief of patient safety for 382-bed Park Nicollet Methodist Hospital, St. Louis Park, Minn., which also made Leapfrogs top 41 list.
While its tough for hospitals to comply with all standards developed by various groups, the Leapfrog survey sets expectations, Schmidt said. But, Its about continuous improvement and it starts with the culture, he said.