What makes a hospital a "best"? A smart, caring workforce armed with the latest technology? Of course. But if that were the magic formula, the only names you'd see in the "America's Best Hospitals" rankings would be those of high-profile, big-money centers that can afford to lure top talent and purchase every new device. Hospitals that fly below the radar, like the 17 facilities in the heart rankings that were cited by fewer than 1 percent of heart specialists who responded to our annual survey, would never appear.
A great hospital is different because of an internal culture of excellence. Set at the top and embraced by caregivers, medical standards are high and emphasize not only doing well but striving to do better—to hammer down the number of infections, to boost survival of high-risk surgery patients, to systematically squeeze out errors rather than painting a scarlet "E" on those who make them. If such goals cannot be achieved by using conventional means, invent new ones.
Vanderbilt University Medical Center in Nashville is no stranger to Best Hospitals—last year it ranked in nine of 16 specialties. But this is the first year it has been named, along with only 18 other facilities, to the elite Honor Roll for its high rankings in multiple specialties. The hospital is huge and growing, with 847 beds; more than 1.2 million patients streamed through its doors in 2007. Most come for routine care, but many come because they need the level of advanced care that only a major referral center can provide.
Last month, two U.S. News reporters paid a five-day visit to the sprawling campus to sample the state of medicine practiced there and get at the personality of the place. They found a blend of pioneering and progressive skills, delivered with a healthy dose of humanity and southern gentility and propelled by that all-too-elusive culture of excellence.
There's nothing mysterious, difficult, or controversial about the routine, but most hospitals are less systematic than Vanderbilt about making sure all of it is done. Fundamental stuff, says chief hospital epidemiologist Tom Talbott, but elusive. "How do we shift to where everybody does all the basics?" he constantly challenges his team.
Safely out of the way at the foot of the bed, Subhasis Chatterjee, a "fellow" taking additional training in cardiac surgery after finishing his general surgery requirements, recites operative details that will guide the patient's post-op care: He had two coronary arteries bypassed, using the left internal mammary artery and a section of saphenous vein from the leg. He required no blood products during the procedure. He can be "fast-tracked to extubation," meaning the ventilator tube can be removed soon. "Any questions?" asks Chatterjee. There are none.