What's Your Score? Looking Under the Lid to Improve Hospital Safety Ratings

Illustration: Lee Sauer

We recently went shopping for a new grill, not because we wanted to, but because we had to. The final blow came when our son lifted the grill lid to load some kebobs and couldn't hide the disgusted look on his face. We knew the grill was nearing the end of its life – grates and burners rusted past the point of salvage – but our inertia and inattention to its sorry state had yet to be acknowledged publicly.

Sometimes it takes a third party to "peer under the lid" and trigger a call to action.

Heeding this clarion call, I announced a grill would make a perfect Mother's Day gift (clean-up is a breeze and my husband tends the grill!). I looked up product reviews and was pleasantly surprised to find the one we liked best received the highest ratings for quality and overall value. A grill I can be proud of now sits comfortably on my patio.

As a society, we are accustomed to the ordinal categorization of excellence. I wanted to know if the grill that looked sleek on the outside would perform equally well once put to the test. I supplemented my "look under the lid" with a product review from a trusted website. I sought out a more expert evaluation of excellence.

For ratings of excellence in healthcare, we have Healthgrades, Leapfrog, Merative (formerly IBM Watson), and U.S. News and World Report, to name a few. When asked about the benefit of identifying the top hospitals in the U.S., the chief medical officer at Healthgrades noted it "takes the guesswork out of making a decision that could have life-or-death implications."

With the recognition of excellence comes an expectation of excellence. In this blog, we'll explore the ratings on hospital safety published by the nonprofit watchdog organization, the Leapfrog Group.

In early May, Leapfrog released its Hospital Safety Grades. They've done so every spring and fall since 2012. Safety Grades are awarded to nearly 3,000 acute care hospitals nationwide, using up to 30 national performance measures from the Centers for Medicare and Medicaid Services, along with the voluntary Leapfrog Hospital Survey and other supplemental data such as patient experience scores. Some facilities, such as Veterans Affairs and critical access hospitals, are not given a safety grade because public data on their performance is limited.

The catchy name, Leapfrog, is a wordplay on the intent to trigger "giant leaps" for patient safety, serving as a "voice for healthcare consumers and purchasers, using their collective influence to foster positive change in U.S. healthcare."

The 2023 report raised concern over the ongoing high rate of three healthcare-associated infections (HAIs): Methicillin-resistant Staphylococcus aureus, central line-associated bloodstream infections (CLABSI), and catheter-associated urinary tract infections (CAUTI). Few healthcare workers were surprised when their incidence hit a five-year high during the COVID-19 pandemic. However, rates remained high in this year's report. Adding to the concern were patient experience measures that showed a continued decline in elements that impact patient safety outcomes, such as nurse and physician communication, staff responsiveness, communication about medicine and discharge information.

Leah Binder, president and CEO of The Leapfrog Group, noted, "The dramatic spike in HAIs reported in this Safety Grade cycle should stop hospitals in their tracks." Recognizing the strain placed on hospitals and their workforce by the pandemic, she called for hospitals to "recommit to patient safety and build more resilience" to address the loss of the pre-pandemic gains.

Should this be our clarion call to look more closely "under the lid" of our facilities and ask if we've become too accustomed to our current state of infections and patient safety lapses? Have we become too familiar with shrugging our shoulders and excusing results because we've lost support staff in the past few years that used to champion the work? How bad are we, really?

With any grading system, the devil is in the details. The Leapfrog Safety Grade assigns a letter grade rating of A, B, C, D and F to depict a hospital's overall performance in keeping patients safe from preventable harm and medical errors. Areas evaluated fall under categories of structure – such as the use of computerized order entry and bar code scanning for medications, process – including handwashing and patient satisfaction measures, and outcomes – measures such as patient falls, CLABSI or CAUTI. The Leapfrog website provides transparency into a facility's composite Safety Grade with a visual performance gauge for each contributing sub-measure. For example, a hospital with an overall Safety Grade of "C" may perform better in a particular sub-measure, such as handwashing, physician communication or bloodstream infections, than a hospital with an overall Safety Grade of "A".  

Clinical and operational team members should take this opportunity to understand their performance and the impact of preventable harm. For example, a CLABSI, defined as a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of central line placement, has been identified as the most expensive infectious hospital acquired condition with an average cost of $48,108. Further, there are an excess of 150 deaths per 1,000 cases of CLABSI.  Unfortunately, these numbers can get lost in a service line's understanding of risk and cost of care, let alone length of stay and patient throughput.

As a specialty that cares for some of the highest risk patients, perhaps the clarion call for the cardiovascular service line is to address the inertia. Begin by understanding various aspects of performance in patient safety and making it a talking point in meetings and care team huddles. Once performance is understood and shared, identify areas for focused improvement and create action plans that address the gaps. As progress is realized, make it real to leaders and care team members; frame success in terms of patient lives impacted, costs avoided, and beds freed by fewer prolonged lengths of stay due to complications. This is critical in an era where margins are slim and resources are closely scrutinized.

Sometimes you need a third party to "look under the lid" and provide a guide for improvement. You may be one of those service lines impacted by position reductions that have left you feeling overwhelmed or bereft of expertise in operational improvement and clinical effectiveness. MedAxiom's Care Transformation Services and Revenue Cycle Solutions teams are here to help you and provide the guidance you need to get to a place you can be proud of.