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Hospital Quality Ratings

Dr. Richard Reece wrote a wonderful personal reflection on the value of hospital ratings.  As you may know, there has been much recent debate about their usefulness.  With all the different rating systems, a single hospital can be ranked #1 in the country by one source and middle of the pack by another.  It’s true that there are many variables to be considered, and that measuring quality is a tricky business.  But one would hope that if we were getting close to observing something real about a hospital, most different scoring systems would lead to the same general conclusion.

The fact that this isn’t the case yet says to me that there is a lot of work to be done in standardizing scoring, developing transparency in the system, and removing hospital marketing efforts from objective data.

I am glad that we’re beginning to shine the light on institutional quality, but there is an elephant in the room.  When it comes to good medicine, the most important factor is the individual healthcare provider.

I have personally witnessed outstanding medical care in the midst of hospitals with poor reputations, and I have observed horrific outcomes at top ranked hospitals as well.  What made the difference?  The provider taking care of the patient.

My insider perspective is that consumers are on the right track with physician ratings – worrying more about getting into the hands of a good doctor, than into the hands of the right hospital.  But physician ratings can be dangerous – if left open to the public without any form of moderation or intelligent analysis, one patient with borderline personality disorder and a grievance could hijack the rating system and destroy a physician’s public reputation.  Safeguards against that sort of behavior can and should be put in place.

The most helpful physician rating system will offer data from multiple sources (patient ratings, peer ratings, health plan ratings) and include sophisticated anti-sabotage algorithms.  It’s also important for the ratings to be protected from self-interests (so that the physician herself doesn’t game the system and use it as a marketing tactic).

Rating quality care is complex, and there will always be a subjective element to it.  Hospitals are run by flawed humans, healthcare providers make mistakes, and yet everyone wants the same thing: consistently excellent medical care.

And that will never happen – so long as humans are imperfect.

As Dr. Reece says,

Unfortunately, variable costs, variable quality, and variable outcomes
are a function of humanity, regional cultures and their constituencies.
Independent variables are part of the human condition. Some of these
variations may be beyond managerial control…

It’s going to take a while to establish criteria to judge and sort out
the good, the bad, and the ugly. Public disclosure of outcome data and
performance data on the processes of care may help, but they are only
part of a complicated human equation.
This post originally appeared on Dr. Val’s blog at

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