May 2010

Here’s the fourth in our occasional series of newsletters on getting better medical care for yourself and your family.Today, we’re discussing hospitals — how to find the right one for you or a family member.  It’s not easy, but I have good practical advice for you.The springboard for my report is a new study about the U.S. News & World Report hospital rankings. I wrote a “blog” in my Patient Safety Blog about this study, and here’s part of what I said:When you walk into the lobby of Johns Hopkins Hospital in Baltimore, you can’t help but notice all the signs informing you that Hopkins is ranked No. 1 hospital in the United States by U.S. News & World Report. Hopkins is justifiably proud of reaching that top spot year after year, but does it mean anything for patient safety and quality of care?

A new study in Annals of Internal Medicine finds that for the 50 top-ranked hospitals, there is little correlation between their U.S. News rank and any objective measures of quality of care. But when the authors crunched the numbers, they found the hospital’s subjective reputation among doctors accounted for 90 to 100 percent of the hospital’s overall U.S. News ranking. In other words, the word of mouth reputation of the hospital among doctors — not among patients — counts for a huge amount of the news magazine’s popular ratings system.

(Read more on the blog here.)

So what’s a patient to do? Read the articles below for some good tips.

How to Look for the Right Hospital — When Going to the Top Isn’t Wise

First, you have to know whether you need to reach for the top: spare no expense to find the top institution in the country, no matter how inconvenient it is to where you live.  This is not always the best strategy.  Here’s an excerpt from what I wrote in my book, “The Life You Save”:

Another approach to finding the right hospital is to find the nearest brand-name institution. If you’re in Minnesota or north Florida, that means the Mayo Clinic.  The mid-Atlantic area: Johns Hopkins Hospital. And so on around the country.  I wish it was that easy.  Big prestigious hospitals like M.D. Anderson in Houston or Johns Hopkins in Baltimore are not necessarily an easy shortcut to top quality care.  None of these hospitals is perfect; no institution of human beings can be.  I’ve sued Hopkins on behalf of injured patients several times.  In one, the care by a pediatric cardiologist was so bad, and so clearly caused the death of my clients’ adorable 3-year-old, that the hospital ran up the white flag shortly after we filed suit, and we reached a confidential settlement. You would make a mistake going to Hopkins without checking out the specific department and the specific doctor whose specialty covers what you need.  The same applies wherever you live.  The nearest mega-hospital connected to a medical school may or may not be right for you. Still, it’s the place where I would start in looking for treatment for any serious disease, whether or not you may need surgery, because the mega-teaching hospital is most likely to have these critical ingredients for avoiding medical catastrophe and getting the best care:

• Sub-specialists in your disease and your kind of treatment.
• A research focus that helps assure up-to-date treatment.
• Teams organized around these sub-specialists to deliver the most coordinated care.
• An institutional focus on preventing errors or catching them before they do harm.

But if you don’t have an exotic condition and instead are laboring with garden variety heart failure or diabetes or any of the other common ailments that fill hospitals, you may be better off with a good community hospital. How do we find the best?

Read on to the next article…

Check Out What Other Patients Have Said on the Medicare Website

(This is another short excerpt from my book.)

Medicare has started requiring hospitals to have patients fill out a standardized survey when they leave the hospital, and the questions focus on a lot of issues that people care about and have a big impact on the quality and safety of their care, such as:

• Did the doctors and nurses always communicate well?
• Was the bathroom always clean?
• Was your pain always well-controlled?
• Was the area around your room always quiet at night?

Note that little word “always.”  These are things patients have a right to expect – always.

To see how this works out in one real-life example, let’s go to New Haven, Connecticut, home of Yale University.  No, we’re not going to Yale-New Haven Hospital, one of the nation’s most prestigious medical institutions.  Instead we’ll drive due west ten miles to the Naugatuck River Valley town of Derby, where we find a hospital named Griffin.

Griffin Hospital gets great patient satisfaction ratings.  Fortune magazine rated it one of the 100 best places to work in America.  And when you see a little of the hospital, you know why.  Here’s how Jim Conway, a top official with the Institute for Healthcare Improvement in Boston, one of the leaders in the field, enthuses about Griffin:

“Driving by, you wouldn’t even notice it, very nondescript,” says Conway.  “But when you walk in the door you know you’re in an extraordinarily different place.  You’ll see musicians playing in the lobby, a fireplace in the cafeteria, just a warm, welcoming environment.  You go up to the unit, and you can not only look in your own chart whenever you want, you can write questions in the chart that you want the doctor or nurse to answer. It’s also set up so families can choose whatever level of involvement they’re comfortable with.”

You can find the results of the patient surveys on Medicare’s Hospital Compare website by clicking here. You will find that many community hospitals do a better job than the mega-hospitals of taking care of patients in the ways that patients notice.

One chain that is quite good that I urge people to check out is called Planetree, which takes its name from the tree under which Hippocrates sat teaching medical students in ancient Greece. Planetree is dedicated to humanizing health care by making it “patient-centered.” Planetree has affiliated hospitals in 31 states; you can see a list at planetree.org.  Griffin Hospital is one of their flagships.

More Resources

There are many other websites that have hospital comparison information. I guarantee you can drive yourself crazy looking at all these sites. That’s why I believe the simple approach of looking at what other patients have said about the hospitals in your area is a sound strategy as long as you don’t require super-specialty care.

But for the really curious, here are two of the leading sites besides Medicare’s:

The Leapfrog Group does voluntary surveys of hospitals and publicizes quality measures that are in addition to those on the Medicare site. Measures include whether the hospital uses computerized order entry systems to cut the incidence of wrong drugs and wrong dosages.

WWW.Healthgrades.com This is a commercial entity that massages the same data Medicare gathers about death and complication rates for various common conditions.