Florida lawmakers are set to pass legislation by the end of the week requiring hospitals and ambulatory surgery centers to report results from patient safety culture surveys that will be posted publicly by the state.
The requirement, which is in House and Senate companion bills, was first introduced in the state legislature several years ago but has only recently gained traction among lawmakers in response to the December 2018 investigation of Johns Hopkins All Children's in St. Petersburg, Fla. The investigation found rising death rates in the hospital's pediatric heart surgery department were ignored by leadership despite vocal concerns from staff.
"Some folks in the Senate felt that those problems that existed (at the hospital) would've come to surface much quicker had this process been in place," said Rep. Michael Grant, a Republican who sponsored the House bill.
The law would require hospitals and ambulatory surgery centers to submit once every two years data from anonymous patient safety culture surveys to the state's Agency for Health Care Administration, which licenses and regulates health facilities. Hospitals and surgery centers must use surveys developed by the Agency for Healthcare Research and Quality with some modifications to include if the respondent would seek care at the facility or unit. A third-party vendor can be used to distribute, collect and analyze the survey for the organization.
The state agency will then display the results publicly by showing an aggregate of performance on the survey's composite measures by unit and at the facility overall. The composite measures include teamwork and hospital management support for patient safety.
Florida appears to be the first state to require this public reporting from its healthcare facilities. Lawmakers believe displaying this information publicly will pressure hospitals and ambulatory surgery centers to change problematic safety cultures, Grant said. Research indicates workplace culture influences quality.
"Whether the people actually working in these (facilities) ... feel comfortable about practicing medicine and treating patients in that facility" is an indicator of quality, Grant added.
The Florida Hospital Association supports the new requirement. It pushed for the agency to display composite measures rather than the entire survey. The hope is that composite measures will be easier for consumers to understand, said Crystal Stickle, interim president of the association. The six-page AHRQ hospital patient safety culture survey largely asks staff to answer questions using scales from strongly disagree to strongly agree and from never to always.
"Our biggest focus was ensuring that the information the public was going to see was something that wasn't going to be complicated, confusing or lead to more questions than answers," she said. "Because (composite measures) are grouped in relatable topics around communication that was a way to achieve a meaningful product at the end of the day."
The Florida Hospital Association also lobbied for a biennial requirement. Every two years should give hospitals enough time to make changes based on the results from the survey, Stickle said. Most hospitals already use AHRQ's patient safety culture surveys and they typically come up with action plans to address problem areas. It takes some time before the survey results reflect the changes providers make, she said.
The Florida Society of Ambulatory Surgical Centers, which has about 225 members, isn't opposed to the new requirement but didn't lobby for it either.
Similar to hospitals, most ambulatory surgery centers already conduct the surveys internally. The society's executive director, Peter Lohrengel, said a main concern initially was that the legislation wouldn't require different surveys for the different settings but that was rectified. AHRQ has a survey specific to ambulatory surgery centers and hospitals.
Quality and consumerism researchers have some concerns about the new requirement. A chief one is there isn't much evidence showing consumers use quality information before seeking a healthcare provider.
"We have a lot of data showing that patients don't use the tools available to them," said Lynn Quincy, director of Altarum's Healthcare Value Hub.
Both proposed bills don't address how the state's Agency for Health Care Administration will inform the public about this information. Grant said he's hoping the agency will receive added funding to market it. Hospitals with strong results will also likely publicize the data themselves, he added.
The bill doesn't dedicate funding to how the agency should display the survey information, said Dr. Don Goldmann, chief scientific officer emertius at the Institute for Healthcare Improvement.
While the composite measures from the survey will be made public, it's unclear how it will be displayed and if consumers will find it useful.
Additionally, even though culture information can help inform the public about quality at a facility, it's doesn't always indicate better or worse performers, Quincy said.
"Honestly, doctors and nurses might not know who the providers are that are getting the best outcomes. That information doesn't typically flow to everybody," she said.
More information along with the survey data such as patient outcomes could give consumers a better understanding of quality, she added.
Finally, the state should monitor the progress of the requirement by working with third-party researchers to test its impact going forward, Goldmann said.
"In my view, this is a large-scale policy test and it should be evaluated by researchers to tell us if it was cost effective and actually led to changes in patient safety," he said. "That really has to be done or this will be just be another thing that hospitals have to report on. At least, we should try to learn from this."
If it passes, the requirement will go into effect July 1, 2020 and will require roughly $163,000 in appropriations.