With the new Best Hospitals rankings online now (health.usnews.com/besthospitals) and out this coming Monday in U.S. News, the magazine, I thought I'd devote a few posts to a few of the more interesting questions that get tossed at me each time the annual guide appears.
The one I probably get most often is why we don't take patient opinion into account. Well, that would be nice. I'd like very much to do that. But how?
The first difficulty is: Where are we supposed to get the information? Lots of hospitals publish "report cards" on themselves that show what patients think of the care they received and the caregivers who provided it. But it's not as if all of these report cards are thoroughly vetted to meet a set of objective standards. Most of them are purely marketing, and they read that way.
So we'd have to devise our own questionnaire or have somebody good at surveys do it for us. That's not a problem—we already use RTI International to run the physician survey that figures in the rankings, and they're good at survey design.
Next difficulty: getting the names and contact information of the patients we'd survey. Hospitals aren't about to hand them over. Even if they were willing, which is as likely as my replacing A-Rod at third base for the Yankees, their lawyers would put a quick stop to it. A small matter of privacy. But we'll make a leap of faith here and assume that somehow we got around this little obstacle.
Difficulty #3 is one of those boring statistical realities: We need lots of responses. You can't poll two or three or even 10 or 12 patients per hospital—that wouldn't be fair or reliable. A small number of people would be dictating the patient score, or whatever we would call it, for each hospital. No, we'd want 50 or 100. There are more than 5,000 hospitals in the United States. That means a survey of 250,000 to 500,000 patients. The logistics blow my mental fuses. Consider that well-done surveys on national issues generally take in no more than about 1,500 people. But we'll ignore this detail as well.
The final difficulty is what the answers would mean. If patients don't like a hospital because they felt they got no respect from their caregivers, that is important. Does it mean that the medical care they received was subpar? Maybe and maybe not. I know of a hospital that has a reputation for treating patients impersonally, as if they were defective widgets that have come back under warranty. It is also one of the best institutions anywhere in treating certain conditions and high-risk patients most hospitals would back away from. Think about that.
Your comments are most welcome. Next time I'll talk about a couple of important specialties that we don't include.
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
Reader Comments