Some Final Thoughts on Best Hospitals

A new survey reveals physicians are often frustrated when they try to improve care.

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Before setting the how and why of the Best Hospitals rankings aside for a while, I'd like to set the record straight on a final couple of points. One reader informed us that he knows that if an M.D. is one of the specialists we survey every year to get the names of up to five hospitals they consider best in their particular specialty, he can make sure his own hospital is ranked simply by writing in its name "even if it is not a very good hospital at all."

Not true, my friend. It would be understandable if a doctor who took pride in her own facility were to vote for it. Or if a hospital, for that matter, encouraged its doctors to fill in its name. (We know of hospitals that have sent out internal letters to this effect.) But the database of more than 850,000 physicians from which we pluck those to survey gives us more than just their name, address, phone number, and specialty. It also identifies their hospitals. RTI International, which runs the survey, came up with a simple program that kicks out any vote for a hospital that comes from one of its affiliated doctors.

One vote hardly guarantees a place in the rankings, anyway. I just took a look at hospitals that didn't make the top 50 in cancer and orthopedics. Quite a few received nominations not just from one physician but several. A hospital does have to have a robust reputation to show up in the top 10 or 20. But a center with no reputation at all will be ranked if its other numbers and indicators—among them death rate, nurse staffing, and advanced technology—are strong. By my count, nine out of 50 hospitals in cancer and 14 out of 50 in orthopedics had a reputational score of 0.0. Zip.

The other correction is aimed at insiders who know—not that it's a secret—that we ask surveyed physicians to name up to five hospitals. Every so often a survey respondent tries to handicap the system by writing in the same name five times. Sorry, but that won't work, either. Another of those handy RTI programs deletes duplicate votes.

The methodology behind the Best Hospitals rankings is hard to game. We like it like that.