Group’s Report Cards on Hospital Safety Seem To Be Having Impact

Andrew Kitchenman | October 24, 2013 | Health Care
Employers, insurers looking at grades as NJ now ranks 9th in nation for best practices

saint peter's hospital
A report card rating safety practices at New Jersey’s hospitals seems to be making a noticeable difference, as marks have been improving since the first report card was issued in spring 2012.

The Leapfrog Group’s Hospital Safety Score report, released roughly every six months, gave “A” grades to 27 of the 67 New Jersey hospitals rated, compared with 23 in the first report card. The state ranked ninth in the country in percentage of states with the highest-level grades.

The scores are based on 28 different publicly available measures, which are weighed based on recommendations from a panel of hospital safety experts gathered by the Leapfrog Group, a Washington, D.C., nonprofit founded by employers and focused on increasing hospital safety, quality and affordability.

Although the group’s first safety report card was only released last year, the organization said both employers and insurers are using scores in determining how they shape health plans.

The grades have proven controversial among hospitals that have lower grades and American Hospital Association officials have said they are unreliable and contain errors.

David Knowlton, president and CEO of the New Jersey Health Care Quality Institute, noted that the scores changed less dramatically this year compared with last year, as the grades incorporated more information. Knowlton is an officer and director for the Leapfrog Group.

“I’m glad that hospitals are attending to it more,” Knowlton said of the response he has heard from hospital executives. “We’re trying to get consumers to pay attention to safety in choosing a hospital and we’re getting a lot of traction with this, which is very heartening.”

Despite increased stability in the grades, four hospitals had their scores change by two full letter grades since the previous report was issued in May. Saint Peter’s University Hospital in New Brunswick, Hoboken University Medical Center and Holy Name Medical Center in Teaneck all improved their grades from C to A, while St. Luke’s Warren Hospital fell from A to C. While no hospitals received a failing grade of F, two had the next-lowest grade of D: Saint Michael’s Medical Center and University Hospital, both in Newark

Saint Peter’s Assistant Vice President of Quality and Safety Joan Gleason Scott said the hospital has been trying to increase its grade as part of a broader effort to ensure patient safety.

Saint Peter’s had already been focused on instituting the best practices endorsed by the National Quality Forum, many of which are measured in the data used to generate the Leapfrog Group grades.

“There was a huge commitment on the part of physicians and administrators and the staff,” Gleason Scott said. She said hospital officials knew that Saint Peter’s was already providing safe care, but they worked to ensure that this was reflected in the report.

Gleason Scott said many of the measures used to determine the grades are improving as a result of the hospital’s effort to improve communication among staff members.

The hospital also had staff members evaluate how others were handling their “handoffs,” which is when a different staff member becomes responsible for patient care and is considered a crucial time for ensuring that errors don’t occur.

“It’s more meaningful,” she said of having staff members get involved in improving hospital safety.

She said she put more weight on the Leapfrog Group grades than many other hospital grading systems, since the methods used to generate the report have gone through a peer review process.

The report released yesterday added two measures: urinary tract infections that result from catheters and infections that occur after major colon surgeries.

Knowlton said some hospital executives have questioned the appropriateness of making changes in the scoring system, but Knowlton said it’s important to include new data as it is determined to reflect patient safety.

“This is a work in progress – it’s not static,” Knowlton said.

Knowlton said hospitals would be well-served to base employee training on the measures included in the grades.

“If you train to the test, you’re providing quality care,” said Knowlton, referring to the national controversy about schools “teaching to the test” in their approach to improving students’ standardized test scores. “We want every hospital to get an A.”

Knowlton said people can benefit from using the grades to determine what hospital to use. He and his wife recently used a mobile application to determine which hospital to take a traveling companion during a recent kayaking trip in western Pennsylvania.

He hopes the grades have the same effect on hospitals that the introduction of a restaurant inspection letter grades had in New York City – within two years, most restaurants with poor grades had either improved or closed.
Leapfrog Group spokeswoman Erica Mobley said that some hospitals have privately expressed an interest in how to improve their grades, even while publicly criticizing the grades.

“Behind the scenes, we have a lot of hospitals contacting us,” Mobley said of the scores.

There have already been improvements nationally in some of the measures used in the scores. For example, more doctors are entering prescriptions through computer systems, which flag potential errors such as adult-level doses prescribed to children.

“Every hospital really has a long way to go toward improving patient safety,” Mobley said.

Insurers are using the grades in determining how they pay hospitals, she added. Other reports on patient safety have also drawn interest from insurers, including the New Jersey Department of Health’s reports.

Wardell Sanders, president of the New Jersey Association of Health Plans, said insurers are trying to use a variety of measures to become “smarter and better” in how they use their purchasing power.

“Plans are increasingly becoming more focused that they’re getting good value for the dollar, so they’re turning to Leapfrog and other ratings to make use of those scores and encourage better outcomes,” Sanders said.