Leapfrog releases hospital safety scores

No Ds or Fs yet — but too many Cs, group says

In a first-of-its-kind survey, The Leapfrog Group graded more than 2,600 hospitals of all sizes and types in the United States on how they performed in more than two dozen weighted patient safety measures — both process and outcomes.

While there were many A grades, including at small rural facilities and safety net hospitals in inner cities where one might not expect it, there were far too many hospitals getting C grades or no grades at all. Those who didn't receive a letter grade in this iteration may find themselves getting Ds or Fs when the survey is repeated late this year: Low scorers were given a reprieve from getting a nasty mark for the first survey, says Leah Binder, president and chief executive officer of the Washington, DC-based organization. In all, about half of the 2,652 hospitals graded received a C or no grade (1,243), while a quarter each earned an A or a B, with slightly more of the former — 729 vs. 679.

While there is a lot of lip-service paid to patient safety, Binder says that progress in patient safety has been "anemic. We need to engage the public in understanding better how important it is to protect themselves when they are in the hospital, and in turn, to put pressure on those hospitals to do better."

The organization had a panel of nine experts determine the best methodology for measuring hospital safety, using publicly reported data. While not all of the hospitals had data for each of the 26 metrics — some were chosen from Leapfrog Group reporting, which is voluntary, Binder notes — it took just 14 metrics to generate a score.

All of the scores were "earned," and are appropriate for the data, she says. But that doesn't mean she wasn't surprised at some results. Cleveland Clinic had a high CLABSI rate, she says, which was one thing that contributed to that august facility getting a C grade. "Even hospitals that have a robust reputation for quality aren't necessarily doing what they have to do to keep patients safe," she says.

Meanwhile, Bellevue Hospital in New York City, Montefiore in the Bronx, and Detroit Receiving Hospital — all serving extremely challenged populations, all safety net hospitals — received As for their safety efforts. "No matter how frail or demographically challenged your patients are, whether you are rural, safety net, or a small community medical center, you can get an A," Binder notes. "The wide range of top-graded hospitals shows that anyone can put patient safety first; you don't have to be an academic medical center."

Binder was quick to note that while press coverage of the report focused on the big-name hospitals like Cleveland Clinic getting a C, the Cleveland Clinic facility in Florida got an A.

While plenty of organizations rate hospitals, Binder says this scoring effort is different because it doesn't just show the top performers, but also the ones who need to improve. "We ourselves have a report that shows the highest achievers," she says. "But it is a good thing to see the range of performance, too."

In the next six months, Binder says the poorest performers will likely be doing some heavy-duty quality improvement: Final grades will be given in November, and after that, the report will happen annually.

For those working in patient safety and quality improvement, Binder suggests looking at your score as a first step (http://hospitalsafetyscore.org/). If you can't find yourselves, it means that Leapfrog didn't have enough data to include you. That might include small facilities in rural areas that don't have ICUs, for example, or organizations that don't participate in Leapfrog surveys or report data to CMS.

After that, look at how other hospitals like yours and those in your area are doing. But don't stop there, she says. "This is a national score, and you might think you are doing well compared to your community, but what if your community isn't doing well compared to the rest of the country? You should know that best performance out there and figure out how to get there."

Go through the list of hospitals, she says. Find the ones most like you that got an A. Then call them, visit them, and ask how they got that grade. "Even if you got an A, you want to continue to look for new ideas so that you can keep that status."

Generally, Binder says, hospitals just don't take enough advantage of the lessons that other hospitals learn. That might mean that the C hospital this round that gets an A in November would be a great facility to call for thoughts — you can bet its quality staff would have learned some lessons.

Binder thinks that shining a spotlight on patient safety in this way will help those working directly in that area because it promotes making it a high priority and gets the attention of C-suite level executives. If a hospital gets a C, you can bet that management will be caring about how to improve that grade, she says. "It shines a light on safety and helps to set a safety-driven agenda."

She wanted to give a special shout out to nurses who lead quality efforts. "In the score we have a pretty heavily weighted measure on the nursing workforce and nursing leadership," Binder says. "If you have a hospital that has achieved Magnet status, you get more points. Nursing staff as a benefit to patient safety is well known, and they should get credit for what they do."

For more information on this topic, contact Leah Binder, President and CEO, The Leapfrog Group, Washington, DC. Telephone: (202) 292-6713.