Recognition Overload

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When Erik Wexler learned that his hospital was a CareScience Award winner, he was skeptical. Wexler, president and chief operating officer of Northwest Hospital in Baltimore, was unfamiliar with CareScience. And like most hospital executives, he’s flooded with invitations to join a multitude of provider listings.

The award’s description—and the notification that Northwest was among the top 1 percent of 4,500 hospitals nationwide—intrigued Wexler, so he asked his care management team to research the award. Wexler’s team analyzed the award’s origin (Wharton Business School), its criteria (excellence in quality and efficiency), and its data source (MedPAR), and he was satisfied with what they found.

“We had no idea they were reviewing any statistics about Northwest Hospital. They weren’t looking for us to pay to participate or for us to hire them as consultants. They just had good intentions of recognizing hospitals with good performance,” Wexler says.

Wexler’s initial doubt concerning hospital rankings is common among hospital executives. While an award might appeal to marketers, senior leaders are often more skeptical—even if they ultimately participate in almost every list. As the industry’s emphasis on quality measurement and transparency has grown, so has the number of hospital rankings and awards. There are dozens of national hospital listings, not to mention hundreds of state- and city-based listings, in which hospitals can participate. But which ones are worth the effort?

What’s in a list?

Do you really need to know what makes up a listing in which your hospital participates? Absolutely, says Barbara Epke, a LifeBridge Health vice president based at Sinai Hospitals of Baltimore. Sinai Hospital leaders won’t publicize any award or rating until they’ve thoroughly researched it, Epke says. Multiple rankings by various sources can confuse customers, so providers must know what consumers are seeing and offer explanations.

Understanding what it means to be at the top is no easy task. Every listing uses different criteria, and a hospital that looks great on one list may not fare as well on another. Some lists focus solely on clinical outcomes, others study financial measures, and still others focus on both. Some awards consider patient experience or length-of-stay data.

No data source is perfect, says healthcare consultant Michael Millenson, president of Health Quality Advisors, a consulting firm in Highland Park, IL. For example, in some cases where a listing uses financial outcomes as part of its ranking criteria, a hospital is a “top” hospital only because of accounts receivable. “I don’t think very many patients would say, ‘The surgery department isn’t good but boy, the billing department is unbelievable. I can’t wait to get there,’” Millenson says.

Some awards do not adjust for severity of condition, patient age or size of facility, which tends to push private hospitals to the top of the heap while public health systems fall. And the data that is publicly available and used for most hospital rankings can be several years old. “When someone gets an award for quality, there should be an asterisk that says, ‘These folks were really good two to three years according to the data that we had,’” Millenson says.

Making it work

Hospitals can reap benefits from awards, however, if they know how to use them. As one of the first recipients of The Joint Commission’s Ernest Amory Codman Award, North Shore Long Island (NY) Jewish Health System is no stranger to rankings and awards. The system has been on lists by Solucient, U.S. News & World Report, and JD Power, to name a few. But for North Shore’s 15 hospitals, winning or losing is not the ultimate measurement of an award’s value. President and Chief Executive Officer Michael J. Dowling says it’s the process of applying for some awards and rankings that really benefits his hospitals.

“The process of responding to the measures and the process of making changes so you look good on the measures or as good as you can, I think, is positive. I may never win, but if going through the process helps me improve my overall performance, I will be very happy,” Dowling says.

Winning an award or appearing on a “best of” list can help motivate staff and build morale. And although the public probably doesn’t understand the difference between one award and another, collectively such honors can build customer awareness.

“It’s not that any individual person can point to an individual award and say, ‘Aha, I’m switching my care there,’ but over time, advertising yourself as having awards builds up a reputation, which in turn helps build up loyalty among both patients and physicians,” Millenson says.

Beyond the benefits to his system specifically, Dowling says hospital rankings can also help the industry as a whole. “Any ranking that shines a spotlight on hospital performance is a good thing,” he says. “It is only appropriate that healthcare providers perform to certain standards, and I think the more there is a focus on performance, the better everyone will get.”

Molly Rowe is a senior editor with HealthLeaders magazine. She can be reached at

List Snapshots

A glimpse at what makes up some hospital ranking lists and awards.

Solucient 100 Top Hospitals: 100 winners are organized into five categories: major teaching, teaching, large community, medium community and small community. It is based on financial and risk-adjusted outcomes, data from MedPAR billing files, and Medicare cost reports. The listing is available free to the public, but hospitals must pay for their individual scores and a more detailed report.

HealthGrades’ America’s 50 Best Hospitals: Awarded to hospitals that receive HealthGrades’ Distinguished Hospital Award for Clinical Excellence for the most consecutive years. The award is based on risk- and age-adjusted mortality or complication data from MedPar. Award recipients and quality ratings for most popular medical conditions are available for free, but consumers may also pay for a more detailed report on an individual hospital.

U.S. News & World Report’s America’s Best Hospitals: Organized by 16 specialties: Scores for 11 specialties are based equally on reputation, risk-adjusted mortality rates from MedPar and quality-of-care factors (e.g., technology, nurse-to-patient ratio). Rankings for five specialties are based on reputation alone because inpatient data is unavailable. Listing is involuntary and available for free to public and hospitals.

Premier, Inc.’s CareScience Select Practice: Uses information from MedPAR data on length-of-stay and clinical indicators. The listing is free and involuntary, but CareScience customers can pay for a more detailed report.

Malcolm Baldridge National Quality Award: Managed by the National Institute of Standards and Technology and awarded annually by the president of the United States if a deserving candidate applies. Applicants must pay to apply, and the process involves an extensive application and review, as well as a site visit for finalists. Applicants receive a thorough written assessment of their strengths and opportunities for improvement.




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