Stop Ignoring Low Quality Ratings

Cheryl Clark, for HealthLeaders Media , September 6, 2012

Conway, former chief operating officer for Dana-Farber Cancer Institute, says that to be truly effective, hospitals should not hesitate to "welcome this level of scrutiny and public accountability. They should acknowledge that they're lagging and that they're early in their journey. But they should say particularly that they've dedicated resources, with specific action plans, to improve outcomes."

Hospital leaders can quibble with the data if they really, honestly have credible information that it's wrong. But they "must be prepared to talk honestly and in a way that can be understood about the gaps in their performance," he says.

"When someone picks a fight about a measure—say one on infections—there's not a lot of public sympathy, because the public wants these damn things eliminated, and they're frustrated," Conway says. Besides, if hospital executives are truly honest, even if they don't agree with their poor scores, they know they can improve. Some hospitals have even offered to send patients to another facility while they fix the problem.

Conway adds that hospital chiefs get frustrated with public reporting because it's based on data that is so old. If there's new data showing improvement, hospitals should let that be known.

Another institution that has chosen transparency is the Roswell Park Cancer Institute, a 133-licensed-bed hospital in Buffalo, N.Y., which as a prospective payment system cancer center is not yet required by CMS to report quality data.

"The driving force behind this was an increasing call from our board of directors that we should have a single place to report cancer quality data," says Stephen Edge, MD, chair of Roswell Park's health services and outcomes research. So in May 2011, the center published a 130-page booklet with details, including some comparative treatment and survival rates, on five types of cancer.

"Ultimately it was our CEO, Donald L. Trump, MD, who said he doesn't want to talk about it anymore, he just wants it to happen," Edge says.

The center's report, downloadable from its website, includes the bad with the good. For example, it acknowledges it has had long average wait times for chemotherapy, 90 minutes in 2009 and 54 minutes in late 2010, still too far off the goal of 30 minutes. Measures include how often patients' primary care doctors received reports on patient treatment, goals to reduce the number of times a patient must have blood drawn, and rates of use of breast-conserving surgical techniques in breast cancer patients.

Conway says that whatever they do, hospitals should not do what they used to when negative stories arose, "which was lay low, hope it vanishes, and take a ‘this too shall pass' attitude. Or, if there's data that says, for example, your coronary artery bypass graft profile is horrible, historically what hospitals have done is to discredit the data. It's sort of like a pigeon in a shooting game.

"But what we've learned is that the organization must ask a critical question: Could this data be right?"

This article appears in the August 2012 issue of HealthLeaders magazine.

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