Few hospitals are close to filling Leapfrog goals

If you’re feeling bad because your organization has not yet adopted the Leapfrog Group’s ambitious campaign to improve patient safety in hospitals, you’re not alone. Though the campaign has drawn praise for its goals, few hospitals are close to meeting the group’s standards for computerized prescriptions, specially trained intensive care unit (ICU) physicians and volume thresholds for certain high-risk procedures.

That’s the conclusion of a study released recently by the Center for Studying Health System Change (HSC) in Washington, DC. Paul B. Ginsburg, PhD, president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation, says the cost of the improvements are a major reason the campaign is not entirely successful.

"Leapfrog has clearly helped put patient safety on hospital radar screens, and many hospitals are trying to meet the spirit if not the letter of the Leapfrog standards by substituting less expensive alternatives," Ginsburg says. "Many factors, including a lack of financial incentives, are hindering hospitals’ adoption of the Leapfrog patient safety practices."

More awareness, but cost is a problem

Formed in 2000 by the Business Roundtable, an association of Fortune 500 CEOs, to stimulate breakthrough improvements — leaps — in patient safety, Leapfrog has championed three hospital patient-safety practices: computerized physician order entry (CPOE), ICU physician staffing, and evidence-based hospital referral, in which hospitals not meeting volume thresholds for six high-risk procedures refer patients to other hospitals that do.

The study used data from an HSC patient-safety survey fielded during site visits to 12 nationally representative communities in 2002-03 and Leapfrog’s public survey data from November 2000 to April 2003. The study was co-authored by Kelly Devers, PhD, a former HSC health researcher and now an associate professor at Virginia Commonwealth University in Richmond, and Gigi Liu, a former HSC research assistant and now a medical student at Stanford (CA) University.

They also found that the majority of hospital executives interviewed by HSC researchers stated that Leapfrog has raised national awareness of patient safety generally and the three safety practices in particular. Despite the positive impact of Leapfrog efforts at the national level, many hospitals reported that employers and health plans in their markets were not providing strong incentives, especially financial incentives, to meet the standards or participate in the Leapfrog survey.

Physicians may resist

Hospitals’ efforts to meet the three Leapfrog standards often are seen by physicians as restricting their autonomy and reducing their productivity and income. As a result, hospitals must work to secure and maintain physician support. One hospital respondent captured the general sentiment well, noting that one of the "fastest ways to the CEO graveyard is to push physicians too hard and fast on patient safety and quality improvement."

Leapfrog’s focus on selected communities — known as regional rollouts — has not yet prompted significantly greater implementation of the three hospital patient-safety practices in targeted communities. On average, hospitals in the five HSC site visit markets — Boston; Lansing, MI; northern New Jersey; Orange County, CA; and Seattle — included in Leapfrog’s initial regional campaigns had not made significantly more progress toward meeting the standards than hospitals in the seven HSC site visit markets not included in the Leapfrog target areas.

The study concluded that efforts to improve patient safety are likely to be more successful if private and public purchasers collaborate to create strong financial incentives for hospitals to improve patient safety.