The Joint Commission, the United States’ leading hospital accreditation board, released its annual report on quality and safety last month. Included in that report was a list of the nation’s top performing hospitals — defined as those that are most diligent in following recognized treatment protocols.
Notably, no New York City medical facilities made the list.
Rankings Focus on Adherence to Procedure
The report honored 405 facilities for their performance in 2010, representing about 14 percent of all Joint Commission-accredited hospitals.
The report graded hospitals on process, not outcome. In other words, the hospitals’ performance was gauged based not on whether their patients ultimately recovered, but rather on whether they followed the correct procedures for dealing with a particular illness or medical problem. For example, hospitals earned points by showing that heart attack patients received aspirin on admission and that surgical patients were given antibiotics within one hour. A process-oriented measurement is thought to be fairer, because it does not penalize hospitals that happen to see a larger percentage of severe cases.
The top performing hospitals list honored facilities that followed the correct procedures at least 95 percent of the time.
Report Finds Disconnect Between Reputation and Performance
Somewhat surprisingly, many of the nation’s most well-reputed hospitals — including the Mayo Clinic, Johns Hopkins, Duke University Medical Center and the Cleveland Clinic — did not make the list. In fact, none of the 17 medical centers listed on the U.S. News & World Report’s “Best Hospitals Honor Roll” achieved the 95 percent benchmark. Over 30 percent of a hospital’s score under U.S. News’ methodology is based on other doctors’ perceptions of the hospital’s reputation.
Small or rural facilities made up a disproportionate share of hospitals named to the list.
The Joint Commission’s president warned that this report illustrates the unfortunate truth that reputation and quality do not always correlate. When choosing a hospital, consumers are well-advised to base their decisions on reported performance data instead of name recognition alone.
Further Disclosure Could Help Promote Hospital Safety
Next year, the Joint Commission will require hospitals to achieve a composite score of 85 percent in order to maintain their accreditation. Based on their 2010 scores, 121 hospitals would not make the grade. These hospitals were not named in the report.
The Joint Commission says the report was intended to honor hospitals that are doing well, not to call out hospitals that aren’t. However, consumer advocates argue that the Joint Commission should be focusing on poorly performing hospitals. They say evidence shows that when public reporting is required, it’s the worst performers that improve the most.