Does the way restaurants are inspected for cleanliness in New York City have anything to teach the people who rate hospitals? Maybe, according to a study released in the February issue of the Journal of Hospital Medicine.1

The authors looked at both Hospital Compare and the restaurant inspection program and compared and contrasted them. Information on the former is housed on a website that consumers must visit, has a time lag of anywhere from one to three years, and includes 108 measures and no summary grade. There are financial penalties for not reporting data, and incentives for improvement.

By contrast, the latter provides point-of-sale information: As the customer enters, there is information on the latest health inspection, and the inspections are done, unannounced, at least once a year. A single summary grade at the location is supplemented by further information on the inspection website.

What the restaurant program provides is clarity, as well as a deterrent factor to potential customers. If customers saw a low sanitation grade, they were less likely to enter. The restaurants that do poorly are subjected to repeated inspections, and closure for severe violations.

“We don’t take the right perspective sometimes, and get caught in a healthcare bubble, rather than get ideas from the rest of the world,” says Andrew Ryan, PhD, one of the authors. “When we design things for Medicare, something is lost in translation in terms of how it’s supposed to affect patient behavior. In other industries, like Consumer Reports, they have to appeal to human beings and how they understand information. They are more sensitive to how information is understood.”

It’s not new, he says, the knowledge that reports like those on Hospital Compare lack an element of easy understandability and that there are easier cues that can be used to help guide patients toward good decisions. “But Medicare hasn’t gotten there with Hospital Compare.” Nursing homes have gone to five stars, and while there are issues with that, consumers are paying more attention and it is more meaningful.

While acknowledging that healthcare is different from most other industries — for example, there may not be many hospitals in a market, or you might not always have the option of choice or a “shoppable moment” — Ryan says researchers who are intimately involved in these efforts have been slow to look at the problem without considering it from the consumer perspective. “Technical considerations like confidence intervals may be lost, but it’s in order to make information more understandable for patients. And there is a middle ground with good science and defensible ways to form composites. You can click for more detail, for example. That would be helpful, to see a default as a letter grade, and for those with an interest in more, it’s available.”

Ryan focused on the New York ratings after living in New York and dining out at lunch every day with a friend who would never go into an establishment with a sub-A rating. “We really responded to the information, and he would go back to the office and look up the ratings.” It got Ryan thinking about why people were so unresponsive to the healthcare ratings, while they were very responsive to the restaurant ratings.

It would be powerful to see ratings on hospitals, Ryan says. “It’s not like people would go from hospital to hospital, but if they were there, people would find out about them in a way that they don’t with the ratings there on the website.”

The response has been largely supportive from peers, but he isn’t sure it has much traction right now. “Summary measures draw attention to information, and it’s viewed as more of a risk, and hospitals are more risk averse,” he says. “I think there is a feeling this could update feelings about hospitals in a bad way, not a good way, and they have a bunch of other things to worry about. But the feeling is that Hospital Compare is moving in this direction. It may not be a star rating on the front door, but who knows what it will be.”

While there isn’t a lot of action you can take right now in this arena, Ryan says there is a message in his work for quality professionals. “There is a lot of information out there for patients — in care summaries and plans, for example. And we know that simple messages are more easily digested.”

For more information, contact Andrew Ryan, PhD, Associate Professor of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI. Email:


  1. Ryan AM, Detsky AS. Grade pending: Lessons for hospital quality reporting from the New York City restaurant sanitation inspection program. J Hosp Med. 2015 Feb;10(2):116-9. doi: 10.1002/jhm.2292. Epub 2014 Nov 25.