Leapfrog accompaniment to “Hospital Rankings Get Serious”

Guest post by Leah Binder, accompanying Hospital Rankings Get Serious

Here’s some stories from my summer reading list. In one story, a woman is stopped by security at the airport when the metal detector goes off. Security guards can find no cause for this and eventually let her board the flight. But this makes her wonder, so she calls her doctor. Later an X-Ray shows a metal retractor in her abdomen, which is a surgical instrument the size of a crowbar somehow left in her body after recent surgery.

Here’s another story in the same book. We’ve all laughed about doctor’s handwriting, and wondered how pharmacists learn to read those scribbles. In this story, a doctor in a hospital handwrote a prescription. The prescription is misread because of the handwriting. As a direct result, the patient dies.

You won’t find this book at the beach, though it’s every bit as harrowing as anything Dean Koontz or Stephen King could dream up: I found these stories in a premier textbook on patient safety: Understanding Patient Safety, by Dr. Robert Wachter. Throw away your memories of dry, highlighter-burned textbooks from your school days, this one is a shocking page turner.

Chilling as the patient stories are, here’s what really raises the goosebumps on your arm: these stories are all true, and worse, they aren’t particularly unusual. There is one medication error per day per hospitalized patient—more in the ICU. One in four Medicare patients admitted to a hospital suffer some form of unintended harm during their stay. An estimated 6000 never events—like that retained retractor–happen every month to Medicare beneficiaries in the U.S.

Despite this, Dr. Wachter’s textbook is oddly reassuring, because the book bursts with 450+ pages of solutions–great ideas, excellent case studies, well researched protocols, and interesting evidence about what hospitals can successfully do to save lives. We have a wealth of evidence and a plethora of dedicated, motivated people in health care who have already demonstrated they can avoid many of these terrible errors.

But if the problems are clear and the solutions abundant, then why are we still losing so many lives? The employers and other purchaser members of Leapfrog concluded that what’s missing is market pressure. Given the many competing priorities hospitals face in this time of turbulent change, consumers and purchasers need to make clear that safety is the priority. That means consumers need to insist on the importance of safety when they talk with their doctors and nurses, and when possible they should vote with their feet to protect themselves and their families from harm in an unsafe hospital. Purchasers need to structure their contracting and benefits to favor and reward safety.

All of this rests on one critical resource: transparency. Consumers and purchasers need to have information about safety in a format that they can use. That is why Leapfrog, a national nonprofit with a membership of employers and other purchasers, launched the Hospital Safety Score.

The Leapfrog Board modeled the Score on the restaurant safety inspection policies recently enacted in Los Angeles and New York City. In those cities, health department inspectors give restaurants a letter grade rating their safety, and restaurants are required to post the grade on their front entryway. Within one year of implementation, a poll found that two-thirds of New Yorkers consulted the letter grade before choosing a restaurant. Distilling complex data into one comprehensible letter grade clearly helped the dining public, so Leapfrog hopes it might work for the hospitalized public. On June 6, 2012, we issued letter grades rating the safety of over 2600 general hospitals across the country. (www.hospitalsafetyscore.org).

To calculate the score using the best evidence, Leapfrog sought advice from a blue ribbon panel of experts that included nine of the nation’s top researchers in patient safety. Dr. Wachter served on the panel, along with three leading researchers from Harvard, and others from Johns Hopkins, Vanderbilt, Michigan, Stanford, and others. These experts advised Leapfrog on which publicly available measures of safety to consider using, and offered guidance in calculating scores using those measures. Leapfrog considered this advice in calculating the grades for hospitals.

Leapfrog’s Hospital Safety Score focuses exclusively on errors, accidents, injuries, and infections in hospitals—the unintended sometimes deadly events that no patient ever seeks out from a hospital stay. There are many other issues affecting the performance of a hospital that Leapfrog did not consider, such as mortality rates for certain procedures or patient experience reports. Other ratings in other places offer perspectives on those issues for consumers.  The Hospital Safety Score rates hospitals on whether they have the procedures and protocols in place to prevent harm and death, as well as the rate of actual harm and death to patients from accidents and errors.

The good news is that hundreds of hospitals are demonstrating excellent performance in safety, and earned an A. But not all hospitals perform as well, and consumers and purchasers deserve to know which is which.

The Hospital Safety Score is one tool among many consumers should use to choose a hospital. We link to other resources on our website, including the Consumer Reports safety ratings and others. Just as consumers can consult several different reviews before making a major purchase like a car, so should consumers consider different views about different aspects of hospital performance. Personally, I will welcome the opportunity to consult a variety of reviews if and when my family faces the critical decision about admission to a hospital. But for me, safety will always come first.

I have met many people who suffered egregious, unnecessary harm in American hospitals, and without exception they tell their story publicly for one reason: to make sure what happened to them doesn’t happen to others. Beneath the Hospital Safety Score and the Consumer Reports rating are the stories of hundreds of thousands of such victims. We calculated our scores because their experience counts.