What if you don't make the grade?
What if you don’t make the grade?
Some top 10’ lists resemble popularity contests
What should you do if a heart patient asks why your hospital’s cardiology unit is not on the "Best of" list she saw in last night’s paper or the current news magazine? Consultants’ opinions vary. You might know your hospital wasn’t included on a given list because the list is flawed or unreasonable. Should you challenge the validity of the list’s scoring criteria? Should you dispute its accuracy?
"No," says Robert Luttman, a health care management consultant in Medfield, MA. "Even if a list is flawed, if the public takes it seriously, you have to take it seriously. The public won’t and shouldn’t pay attention to wrangling over numbers and data and calculations. The impact of what they read or heard is a part of the public consciousness. It’s too late to do anything about it."
Michelle Pelling, MBA, RN, president of the PROPELL group in Portland, OR, does not completely agree. "If you can see that one particular list places an inordinate emphasis on length of stay following open-heart surgery, for example, you can explain that its criteria didn’t include service and quality of care. If it had, your facility would be right up there. When confronted with a question regarding the list, respond according to the particular issue." (See article on criticism of U.S News & World Report’s "America’s Best Hospitals" ranking, above. See chart of hospital rankings, p. 126.)
Another, perhaps more constructive tack is to take a proactive stance. "Decide what list you want to make," says Pelling, "and use those measures to improve your own performance. You have to shoot for excellence."
Being on a top-10 list can, without a doubt, be a good marketing tool, but statistics can work for or against you. Many fine facilities are often not included. Reasons vary, but the first questions you should ask are, "Who put the list together?" and "On what basis?"
"You have to look at where the lists are coming from to make sense of them," Luttman says. "What are the criteria? What is the scoring system?"
Small rural hospitals with less severe populations have been known to get on lists that large urban hospitals miss. The smaller facilities don’t handle the complex cardiac cases those patients are sent to the larger tertiary facilities and their mortality rates are low.
"I’m skeptical of most lists. If you ask a cardiologist his opinion of a hospital and then ask a hospital administrator the same question, they will have different opinions," says Sharon Baschon, RN, a utilization management consultant in Durham, NC. "Most top-hospital lists are based on subjective parameters."
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