Maybe you’ve wondered about the usefulness of hospital report cards — you know, the “grades” the state Health Department periodically gives every hospital in the state on such “subjects” as a surgical procedure like angioplasty or post-surgery complications like pneumonia.
Let’s face it: When you’re having a heart attack, the last thing you’ll do is look up the data to see which hospital you should go to. You’ll go where the ambulance takes you, or where your doctor has privileges.
The report card’s real value lies in the pressure public disclosure places on hospitals to heal themselves — and deliver safer, better care to us. The state Health Department’s most recent report on hospital-acquired infections is a case in point.
These are the types of infections patients picked up after they got to the hospital. Nasty bugs like MRSA (methicillin-resistant Staphylococcus aureus) kill an estimated 100,000 people in the United States every year. Not every one of those deaths is preventable, but many are.
The health department looked at infection rates in 13 categories for every hospital in the state. In 2011, Upstate University Hospital had a significantly higher infection rate compared to the state average in its pediatric intensive care unit. After seeing that spike, Upstate changed the way its staff handles central-line catheters that deliver fluids and medications to seriously ill patients. More important, the hospital changed the institutional view that infections are unavoidable. Upstate’s goal now is to have zero infections.
That goal is within reach. For example, St. Joseph’s Hospital Health Center achieved zero infections last year in operations to remove blood vessels for use in heart bypass surgery. Among the hospital’s many efforts to prevent infection, the most important one also was the simplest: getting more staffers to wash their hands. The rate of hand-washing rose from 75 percent to 97 percent, hospital officials report.
Would these changes have been made if the infection rates were not made public? Probably. But knowing they will be made public — and that a bad report card is bad for business — is a powerful incentive for hospitals to constantly improve.
New York was among the first states to compile hospital report cards, starting in 2007. Hospitals chafed at what they considered to be an apples-to-oranges comparison with their counterparts across the state. Some critics of report cards also say the data may be out of date, and hospitals with real-time data at their disposal are already on top of fixing problem areas.
That may be so. But there’s no arguing with the impact public disclosure has had on delivery of quality health care. For example, since the state began reporting hospital infection rates in 2007, the rate of central-line bloodstream infections has dropped 41 percent, while surgical site infections have decreased 13 percent. Those improvements are astounding. Yet there’s still room for more.
Hospitals are a complicated environment for delivering health care — perhaps because health care itself has gotten so complicated. Readers of The New Yorker may be familiar with the work of Atul Gawande, a surgeon and public health expert who writes elegantly about those complexities. In a recent essay, Gawande looked at how the restaurant chain Cheesecake Factory is able to churn out made-to-order, high-quality, uniform and reasonably priced dishes in each of its 170-plus locations across the country.
“In medicine, too,” Gawande wrote, “we are trying to deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality. Unlike the Cheesecake Factory, we haven’t figured out how.”
Unlike restaurant customers, health care customers can’t vote with their feet. Quality data like hospital report cards are an indispensable tool for making health care providers accountable to their customers.