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A safe patient is an informed patient.  In today’s world, that means hav­ing the infor­ma­tion we need to make informed health­care choic­es.   Nowhere is this more impor­tant than in the hos­pi­tal set­ting.

In the Unit­ed States, the move to make hos­pi­tals safer has spun a vir­tu­al cot­tage indus­try of rat­ing sys­tems that score hos­pi­tals on the basis of a num­ber of indi­ca­tors, includ­ing patient safe­ty mea­sures. The Leapfrog Group, a non‐profit that traces its roots to one of the founders of the mod­ern patient safe­ty move­ment, Dr. Lucian Leape, recent­ly released the first of its semi‐annual rat­ings for 2015, scor­ing some 2,500 hos­pi­tals across the coun­try. Using pub­licly avail­able data on Medicare’s Hos­pi­tal Com­pare web­site, as well as its own sur­veys of hos­pi­tals, Leapfrog assigns a let­ter grade from A to F to arrive at what it calls the “hos­pi­tal safe­ty score.” The results are avail­able on its web­site.

Oth­er hos­pi­tal rat­ing sys­tems are run by the Joint Com­mis­sion, a non­prof­it group that accred­its hos­pi­tals in the U.S., and the pub­li­ca­tions U.S. News and World Report andCon­sumer Reports. Some states have devel­oped their own rat­ing sys­tems. Cal­i­for­nia res­i­dents can check out their hos­pi­tals using any of the eleven dif­fer­ent eval­u­a­tion sys­tems that grade health­care facil­i­ties in that state.

To under­stand why hos­pi­tal report cards have cre­at­ed such inter­est, con­sid­er this exam­ple. Say you live in Brook­lyn, N.Y., and your near­est hos­pi­tal is Brook­dale Hos­pi­tal. But you don’t like the fact that Brook­dale was scored an F in its three most recent rat­ings. You could look on the handy map the rat­ing ser­vice thought­ful­ly pro­vides and con­sid­er tak­ing the short dri­ve to Kings­brook Jew­ish Med­ical Cen­ter, which got a B rat­ing.  Some­times even one or two grades can mean the dif­fer­ence between a life‐threatening infec­tion and a full recov­ery.

As con­sumers, we’ve long insist­ed on hav­ing access to infor­ma­tion about the prod­ucts we buy — whether they’re auto­mo­biles or cof­fee mak­ers.  The same trans­paren­cy pres­sures are now over­tak­ing the health­care sec­tor.

Except in Cana­da.

In Cana­da, there is no com­pre­hen­sive nation­al hos­pi­tal rat­ing sys­tem com­pa­ra­ble to those wide­ly used in the U.S.  Hos­pi­tal com­par­isons that do exist are woe­ful­ly lim­it­ed in the infor­ma­tion they pro­vide and are hard to deci­pher. It’s dif­fi­cult to see how they are pub­lished with the inten­tion of being eas­i­ly acces­si­ble and under­stand­able to ordi­nary patients and fam­i­lies.

In prepa­ra­tion for this piece, I asked a senior cit­i­zen, a teen and a reg­is­tered nurse to vis­it the web site of the Cana­di­an Insti­tute for Health Infor­ma­tion (CIHI), and to locate data about their local hos­pi­tal.  None found the infor­ma­tion they were look­ing for in under 20 min­utes.  The teen resort­ed to the oblig­a­tory pro­fane adjec­tive after 5 min­utes.

By con­trast, when asked to locate health­care infor­ma­tion for Brigham and Women’s Hos­pi­tal in Boston, all locat­ed it from Leapfrog’s Hos­pi­tal Safe­ty Score site with­in 30 sec­onds.  There was no pro­fan­i­ty.

In the province of Ontario, Health Qual­i­ty Ontario pro­vides raw num­bers for some indi­ca­tors of patient safe­ty, like infec­tions and hand hygiene com­pli­ance.  But if you want to eas­i­ly com­pare one hos­pi­tal to anoth­er, the implic­it mes­sage from the lim­it­ed and cum­ber­some way the data are pre­sent­ed is “go fig­ure it out your­self.”  There is no over­all score pro­vid­ed for hos­pi­tal safe­ty.

Two years ago, in a ground‐breaking inves­ti­ga­tion, the CBC rat­ed Cana­di­an hos­pi­tals using the U.S. mod­el of let­ter grades from A to F. There were a num­ber of sur­pris­ing find­ings, like the fact that Canada’s largest teach­ing hos­pi­tal,  Sun­ny­brook Health Sci­ences Cen­tre in Toron­to, scored only a C.   Anoth­er big teach­ing hos­pi­tal,  UBC Hos­pi­tal in British Colum­bia, ranked a dis­mal D.

There have been no follow‐up rat­ings since the CBC’s inves­ti­ga­tion in 2013.

It’s hard to see how the absence of a robust, clear­ly under­stand­able rat­ing sys­tem is good for patients and fam­i­lies.

Rat­ing sys­tems are not infal­li­ble.  Dif­fer­ent scor­ing agen­cies some­times come up with dif­fer­ent rat­ings for the same hos­pi­tal on the same per­for­mance cri­te­ria.  Most sur­veys depend on infor­ma­tion that is col­lect­ed and report­ed by the hos­pi­tal itself, which rais­es anoth­er lim­it­ing fac­tor, as the Office of Inspec­tor Gen­er­al deal­ing with Medicare and Med­ic­aid in the Unit­ed States dis­cov­ered: a high per­cent of med­ical errors in the hos­pi­tal set­ting are sim­ply are not report­ed.

Many patients and fam­i­lies talk about an expe­ri­ence with a hos­pi­tal cul­ture that resorts to deny and defend when they seek answers about what hap­pened to a loved one who expe­ri­enced harm.  I have encoun­tered that cul­ture first‐hand myself and know how frus­trat­ing it is.

Despite inflict­ing dai­ly errors on my moth­er, includ­ing med­ica­tion mis­takes and break­downs in prac­tices to pre­vent pneu­mo­nia, pres­sure ulcers and mal­nu­tri­tion, a major con­vul­sive brain seizure and a car­diac arrest, over the course of her six‐month hos­pi­tal­iza­tion, the two hos­pi­tals involved, includ­ing one of Cana­da largest teach­ing hos­pi­tals, denied even a sin­gle error ever occurred.

Hos­pi­tals that are pre­pared to hide or cover‐up the truth are not like­ly to ful­ly report harm and errors on a vol­un­tary basis.

Still, a rat­ing sys­tem is a good start in shift­ing the trans­paren­cy par­a­digm away from the dark shad­ows that serve entrenched inter­ests towards one that makes patient pro­tec­tion first.  It also gives the best providers a chance to show­case their com­mit­ment to safer, more patient‐ and family‐centered care. When U.S. hos­pi­tal rat­ings are pub­lished, they usu­al­ly attract a good deal of media, and thus pub­lic, atten­tion. None of this hap­pens in Cana­da.

Cana­da has a nation­al health­care sys­tem.  What it needs now is a nation­al rat­ing sys­tem for its hos­pi­tals. It needs to be fair, trans­par­ent and easy to under­stand for those who are pay­ing the bills. On that point, imag­ine the huge sums that might be saved if hos­pi­tals actu­al­ly cut the rate of errors.  Hospital‐acquired infec­tions alone cost Cana­di­an tax­pay­ersmore than $1 bil­lion every year, yet Cana­da has one of the worst records for deal­ing with HIAs of all high‐income nations, accord­ing to the World Health Orga­ni­za­tion.

Hos­pi­tal med­ical errors in Cana­da are the third lead­ing cause of death. There should be no ques­tion that it is time to bring a nation­al rat­ing sys­tem to the country’s hos­pi­tals, and the high­er lev­el of patient safe­ty that will hope­ful­ly accom­pa­ny it.

Com­ments can be sent to Kathleen@PatientProtection.Healthcare

 

 

 

 

 

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A safe patient is an informed patient.  In today’s world, that means hav­ing the infor­ma­tion we need to make informed health­care choic­es.   Nowhere is this more impor­tant than in the hos­pi­tal set­ting. In the Unit­ed States, the move to make hos­pi­tals safer has spun a vir­tu­al cot­tage indus­try of rat­ing sys­tems that score hos­pi­tals on […]

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