National rankings offer patients valuable insights into a health system's care quality, outcomes and performance, helping them make informed choices. But to what extent do these ratings influence health systems' strategies and conversations surrounding quality?
Becker's recently spoke with physician executives from four health systems to understand how they view national rankings, communicate them to their teams and whether they tailor their quality strategies around them.
Many leaders said they place more weight on national benchmarking data from private third-party organizations due to the retrospective nature of national rankings such as Leapfrog's safety grades, CMS' Overall Hospital Star Ratings or U.S. News & World Report's best hospitals. Leaders also emphasized the importance of keeping staff focused on high-reliability principles and their core purpose of serving patients, noting that strong ratings will naturally follow.
Editor's note: Responses have been lightly edited for length and clarity.
Andy Anderson, MD. Executive Vice President and Chief Medical and Quality Officer at RWJBarnabas Health (West Orange, N.J.): The most important perspective is our patients and communities, and making sure that we provide the best possible outcomes. The national rankings and ratings reflect that for the most part, so there's pretty good alignment there. We tend to look at Leapfrog, CMS stars and U.S. News because they all have a slightly different focus and there's actually quite a bit of alignment underneath. For example, HCAHPS is included in the methodologies for all three. For us, Leapfrog is more about safety, CMS stars are more about quality, and U.S. News is a bit more about service lines and tertiary quaternary centers of excellence. All three show up in the newspapers and align with things that are very important to patients, such as their experience, safety and outcomes. Our day-to-day work is more focused on those outcomes and monitoring and making sure we have tactics in place to improve them, and then doing continuous quality improvement around those tactics.
The messaging that I tend to use [with staff] is that the national ratings will follow as we make these improvements. We do have aspirational goals. We want to have straight A's from Leapfrog. We want to be four and five stars with CMS. We want to be ranked in the top 50 with U.S. News. Those are part of the plan, but we've been purposely communicating that it takes time to get from here to there. Focusing on things like mortality and HCAHPS are really powerful levers that are going to get us there.
Phillip Chang, MD. Senior Vice President and Chief Medical and Quality Officer of Memorial Hermann Health System (Houston): We review all of them and educate ourselves on the key ones as much as possible and allowable. These include data from federal and state programs, common ones like Leapfrog and U.S. News, along with private third-party rankings. Some of it is obviously very retrospective.
We look at all of them, and we make a determination of all the literally hundreds of measures, what's important to us? From there, we design our own quality scorecards. Because we're so large and complex, we've got one for the traditional hospital space. We have one for various service lines. We're building one for post-acute rehab and for the children's hospital. I think the goal is, once we fully convert to Epic and everybody takes a breath, we'll also have a balanced scorecard for the ambulatory space. The scorecards are set once a year, and we look at last year's data for goal setting. We have a dozen-plus measures that we've identified as the most important.
We do rely very heavily on a third-party clinical database, because the benchmark data we get back from it is the closest to real time. We don't set a specific number across the entire system. We want to look at every campus — and in the future, maybe every unit — to see how they perform currently and set a target that is better. And then we take another step further and we look at where that hospital is compared to national benchmarking. So that's our strategy right now. It' a lot of work, but it's worth it.
Peggy Duggan, MD. Executive Vice President and Chief Medical Officer of Tampa (Fla.) General Hospital: One of the challenges [in tailoring your quality strategy around certain rankings or ratings] is there's a lot of delay in the data. So you have a hard time knowing if the activity you are undertaking today is going to impact the score you're trying to reach in two years. With certain rating or scoring groups, even the components can be in different time frames. Every single rating also has different components, which then can have you chasing a lot of things rather than doing the right work.
At Tampa General, we use a quality database of large academic health systems as our North Star because we can actually see the most current data and our impact when we start an initiative. You need to know your data and parse it down to ensure the work is doable. We can say we want to improve our rankings by a certain amount, and that's the systemwide goal. But how you get there is like 1,000 little projects, and you have to cascade that down. You need enough data literacy within the organization so that people can understand the data and see the impact of their work.
We are also on a high-reliability journey as a way to drive quality for the right reasons. For clinicians, the why is always going to be improving patient care. They're not going to be so interested in rankings or scores as much as doing the right thing for our patients. Tampa General Hospital is the first academic health system to receive two qualifications for its collaborative just culture program and reliability management team. Our goal is to be the first academic health system in the country that's certified as a Collaborative High Reliability Organization by DNV. We really believe our front line is our best defense from any kind of issues — operational challenges, patient safety issues, quality issues — so we really want to activate our front-line staff so that they can be driving the quality changes that lead to the best outcomes for our patients. That will drive all the right scoring as time goes on.
Wayne Lipson, MD. Senior Vice President and Chief Medical Officer of Methodist LeBonheur Healthcare (Memphis, Tenn.): We use national benchmarks, rankings and ratings to monitor, track, measure and hold ourselves accountable. We like to use the national benchmark because it normalizes the data to give a true representation of how we compare to other high-performing healthcare providers. We use it to measure timeliness and efficiency, to give us the greatest potential for growth, but also sustainability, because we can have growth, but if we don't sustain the gains, then we haven't done much to help improve our patient care.
Methodist as an organization outpaces our local competitors in quality and safety. We look to industry standards for excellence. But what's really great about Methodist LeBonheur is that we look outside healthcare to find best practices across multiple industries. For example, we model ourselves after high-reliability organizations within the airline or nuclear power industry. Our goal at the end of the day is to be top-ranking for all types of care we provide across all our service lines. And we strive to be top decile as an organization. That's considered lofty, but we feel that that is what our patients deserve and, frankly, expect.
Our associates from all disciplines go the extra mile for patients and families. For us, the mile isn't even extra. It's who we are. It's carved into our philosophy and culture and the fiber of who we are as an organization. We're not going to invest our time and energy into these things simply because we get honors and recognition — this is to ensure we meet the mark every time.