Paul Levy, head of Beth Israel Deaconess Medical Center in Boston, enjoys stirring up a fuss on his blog, Running a Hospital. He loves tossing out challenges—twisting people's heads around a little so they have to regard a question from a different angle.
Now he has proposed that U.S. News give extra credit in the "America's Best Hospitals" rankings to hospitals that let everybody see how well or badly they're doing at keeping patients safe. Compared with other hospitals, for example, what is the rate of infections related to surgery and central venous lines? Thanks a lot, Paul. I can't wait for the outraged calls and E-mails from hospitals if we take you up on it.
On the other hand, I like the concept, and Levy is willing to put his data where his mouth is. "Transparency" is a big deal to him, and he's made Beth Israel Deaconess much more transparent during his relatively brief tenure, as I've noted previously.
Is his idea a good one? Is it workable? Tell me what you think.
Here are a few excerpts from his modest proposal.
I am talking about substantive clinical metrics, like central line infections, ventilator associated pneumonia, and the like. Or the ultimate, the hospital standardized mortality rate calculated by the Institute for Healthcare Improvement.
I can already hear the arguments against this. Who is going to validate the numbers? Which definition of central line infections should be used? How would you compare from hospital to hospital?
Please, put all that aside. Let's just accept as a premise that hospitals that choose to post these numbers do so not for comparative or competitive purposes, but rather to hold themselves accountable to the public for their efforts in quality and safety improvement. Shouldn't that be worth something in the U.S. News listing?
A fallback, if you don't want to change your algorithm. Just create a special box listing the hospitals that post these kinds of results, along with their URL, so people from hospitals around the world can check in and make their own judgments about the usefulness of this approach.
Why not use [your] influence to push the industry along to greater heights by giving space to those who risk holding themselves accountable in this manner?
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.
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