Leapfrog standards are hard for hospitals to meet

Some hospitals trying less costly alternatives

While The Leapfrog Group’s ambitious campaign to improve patient safety in hospitals has sparked national awareness, 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, according to a study released by the Center for Studying Health System Change (HSC). HSC, based in Washington, DC, is a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.

"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," said Paul B. Ginsburg, PhD, president of HSC, upon announcing the survey results. "Many factors, including a lack of financial incentives, are hindering hospitals’ adoption of the Leapfrog patient-safety practices."

Formed in 2000 by the Business Roundtable, an association of Fortune 500 CEOs, to stimulate breakthrough improvements, or leaps, in patient safety, Leapfrog has championed three hospital patient-safety practices:

  • Computerized Physician Order Entry (CPOE) — whether hospitals have an electronic prescribing system to prevent medication errors.
  • ICU Physician Staffing — whether hospitals use physicians board-certified in the subspecialty of critical care medicine to provide care in adult medical and surgical ICUs.
  • Evidence-Based Hospital Referral — whether hospitals meet volume thresholds for six high-risk procedures, with hospitals not meeting the thresholds referring patients to other hospitals.

The study’s findings are detailed in the HSC issue brief, Leapfrog Patient-Safety Standards Are a Stretch for Most Hospitals.

Based on site visits to 12 nationally representative communities in 2002-03, the study examines hospital patient-safety activities in Boston; Cleveland; Greenville, SC; Indianapolis; Lansing, MI.; Little Rock, AR; Miami; northern New Jersey; Orange County, CA; Phoenix; Seattle; and Syracuse, NY. Additionally, the study used data from an HSC patient-safety survey fielded during the site visits and Leapfrog’s public survey data from November 2000 to April 2003.

Other key study findings include:

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.

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, northern New Jersey, Orange County, 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 found that while many hospitals have not fully implemented the Leapfrog standards, many are implementing less costly alternatives or testing CPOE systems and ICU specialists on a smaller scale.

"We appreciate The Leapfrog Group’s goal of improving quality and patient safety, but hospitals have found that its standards are not the only ways to reach that goal," notes Nancy Foster, American Hospital Association senior associate director of health policy. "Marking surgical sites, improving the use of alcohol-based hand gels, and other innovations have been broadly adopted, while the use of patient volume as a marker of quality has been shown by a recent RAND study to be a poor indicator. Hospitals already have extensive quality improvement efforts under way and, through the Quality Initiative, are working with federal agencies, researchers, consumer groups, and many others to develop and share their performance on a robust set of valid, evidence-based patient safety measures."

The study concluded that efforts to improve patient safety are likely to be more successful if private and public purchasers collaborate to create strong incentives — particularly financial incentives — for hospitals to improve patient safety. The public sector also could complement Leapfrog efforts through collaboration on research, information technology, reporting, and purchasing approaches.

Need More Information?

For more information, contact:

  • Center for Studying Health System Change, Washington, DC. Web site: www.hschange.com.