On the Mark
Do hospitals’ ratings
indicate quality?
 
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High Rank,
High Job Satisfaction?

U.S. News & World Report calls on the Chicago-based National Opinion Research Center to sort through pages of data to come up with its annual ranking of “America’s Best Hospitals.” Using a three-pronged approach that is equal parts reputation, mortality rates, and other data including nursing care, the analysts distill the information into the annual list.

The end product may play a role in a hospital’s marketing efforts, but at the bedside, is there a correlation between a high ranking and greater job satisfaction? Most nurses say there is, though job satisfaction usually results in a high rating, as opposed to the other way around.

“Anecdotally, what I’ve heard is that the rankings provide tremendous pride in the hospitals that rank very high,” said Avery Comarow, the editor in charge of the U.S. News rankings since they debuted in 1990. “But for the people there, they are more a validation than a revelation. They already know they work in a good place. [The rankings] just confirm what these people already know.”

Many feel the rankings provide both pride and inspiration. Susan Tyler, NP, RN, director of geriatric services for the University of Texas Medical Branch at Galveston, which was ranked 45th in geriatrics, said the rankings “are one of the things that add to job satisfaction. You certainly can’t live or die by the rankings, but the ranking is a validation for doing worthwhile work.”

“I think it plays a big role in job satisfaction,” said Vickie Poole, RN, the charge nurse at the Scott & White Memorial Hospital outpatient oncology clinic in Temple, Texas, which was ranked 50th in cancer care. “We didn’t expect it. It came as a surprise, but it is the result of taking pride in your work.”

Barbara Quast, RN, a staff nurse at Baylor’s Charles A. Sammons Cancer Center, said the ranking boosted staff morale. “Employees take pride in it, and I take pride in it.”

Others think the more important evaluations come from the Joint Commission on Accreditation of Healthcare Organizations, which makes decisions based on 500 criteria. Sharon Woolley, RN, an emergency room nurse at Texas Children’s Hospital in Houston, said the hospital has received the JCAHO’s highest ranking for the last three years. She thinks this ranking is more a point of pride than its No. 10 U.S. News ranking. “We can be at the top without having this national survey,” she said.

~ Chris Schreiber
 
   

By Chris Schreiber
Photo: Corbis
October 11, 1999

Americans like lists. They are easy to understand and hard to put down, although they are also subjective, imperfect, and limited in scope. But on the right list, no one wants to be left out, and hospitals are no different.

Hospitals are ranked nationally and locally by media and industry. Some tout their rankings in ads while others keep quiet about it. But when you get past the publicity and the numbers, what do rankings really mean for hospital employees and healthcare consumers? Some say the rankings are just one piece of information consumers can use to make decisions, while others say they’re more confusing than illuminating.

The raters themselves know hospital rankings shouldn’t mean everything. “We don’t intend for anyone to take these rankings as the final word,” said Avery Comarow, a senior writer on the medical beat for U.S. News & World Report and the editor of the best-known hospital rankings, the magazine’s annual “America’s Best Hospitals.” Comarow insists the rankings are meant simply to assist consumers with healthcare decisions.

Validation and pride

“Rankings are an external validation about what we already believe about ourselves,” said Kevin Wardell, chief operating officer and executive vice president of the University of Texas M.D. Anderson Cancer Center in Houston, which was ranked in four specialties by U.S. News, including a No. 2 spot for oncology. “For a consumer, the list is a starting point. It’s not a bad list to begin with, but it remains very difficult for a consumer to sort out clear quality issues. The data is difficult to obtain and difficult to compare, and that’s why a shorthand list like this is important.”

How important is a matter of debate. To some healthcare professionals, rankings are a source of pride. “I think consumers should pay a lot of attention to them,” said Barbara Quast, RN, a staff nurse at Baylor University’s Charles A. Sammons Cancer Center in Dallas, which is home to one of 11 specialties for which Baylor was ranked. “When a hospital is ranked, it shows that they are committed to quality care and community service.”

To others, the rankings matter little. “To be honest, I read those rankings, and I personally felt that they didn’t mean that much to me and they meant even less to the parents of the children I take care of,” said Sharon Woolley, RN, a staff nurse at Texas Children’s Hospital in Houston, ranked No. 11 in pediatrics. “We looked up the rankings on the computer, and people were talking about it, but it was soon forgotten.”

Publicity seekers

But hospitals that make the U.S. News list and others like it want to make sure the award doesn’t fade as quickly from the public’s memory. Called “the hottest marketing tool in health care” by The Wall Street Journal, the blue and gold “best hospitals” seal conveys brand recognition for consumers. At least that’s what hospital marketing directors are banking on.

Comarow says that he “could not care less about the marketing angle of hospitals” and that the rankings aren’t intended to help PR departments. But oftentimes that’s what happens.

High rankings “reinforce the quality perception people have of us,” said Cindy Matthews, vice president of marketing services for Baylor Health Care System, which features its ranking on billboards and print ads. But other hospitals opt not to use the ranking in ads. Steve Sievert, director of marketing communications at Texas Children’s Hospital, said the seal is featured “fairly prominently on our Web site,” but that the hospital’s latest television and print ads don’t refer to the rankings.

Other methods

The U.S. News rankings factor in reputation, which experts say helps drive up the brand recognition. But the country’s best-known alternative to the U.S. News rankings, HCIA’s “100 Top Hospitals—Benchmarks for Success,” doesn’t rely on a subjective reputation component, according to officials from HCIA Inc., a healthcare information company based in Baltimore. The survey, published for the last six years by HCIA and consulting company William M. Mercer, lacks the brand recognition that the reputation angle helped foster.

That’s just fine with HCIA. “100 Top Hospitals is unlike the U.S. News & World Report rankings,” said Jean Chenoweth, senior vice president of HCIA. “It’s pure data analysis. It rewards benchmark performance by management teams. We make no bones about it. Our study is a management award. We believe that a good hospital is a well-managed hospital and that good management equates to good quality health care.”

Confusing the public?

What hospitals “do” with their award, however, can be confusing to the consumer, said Rick Wade, senior vice president of the American Hospital Association. Just as some hospitals ranked by U.S. News advertise their ranking, some recipients advertise their HCIA designation, Chenoweth said.

Wade thinks consumers often lack the knowledge needed to put rankings in perspective. “I don’t know if the public can make the connection between clinical outcomes and a hospital’s financial situation,” Wade said. “While these [rankings] can be useful tools for a consumer … we have to clarify what is being measured. There is a danger in confusing the public by doing an inadequate job of explaining what is being measured.”

Others agree. “It’s important for consumers to realize when they see these lists what criteria are being used,” said Martha Radford, MD, a cardiologist and deputy director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital. Radford and four others wrote a critical assessment of the HCIA rankings this summer. She said their study revealed that HCIA’s top hospitals did not deliver significantly better care than those not rated. “Rankings don’t necessarily correlate with quality of care,” she said.

U.S. News acknowledges as much. The magazine ranked more hospitals this year than ever before—188—but there are 6,111 more in the country that aren’t mentioned. Not appearing on the U.S. News list is by no means a death knell for a hospital. Hospitals pop up on other lists as well—some in unexpected locations.

Unheralded quality

Baptist Health Systems, headquartered in Coral Gables, Fla., illustrates the point. The company has spent the last two years on Fortune magazine’s list of the “100 Best Companies to Work For.” This year, Baptist Health moved up 20 spots to No. 69 on the list, cited by the magazine for 1997 revenues of $530 million, a 10 percent annual increase in jobs, and a 38-year history of no layoffs.

Fortune makes no effort to assess the quality of health care at Baptist Health’s dozen or so hospitals and clinics in South Florida. In this case, however, the bottom line seems to be a good indicator of the health system’s standing in the community. The company’s Baptist Hospital last year was named one of 11 “Magnet Hospitals” in the country for excellence in nursing by the American Nurses Association. And local publications like Miami Metro put Baptist Health’s South Miami Hospital on its list of top hospitals in South Florida. But the only area hospital to make the U.S. News rankings this year was the University of Miami, Jackson Memorial Hospital.

Comarow acknowledges that all rankings are limited in scope. But healthcare experts seem to agree that despite their shortcomings, rankings generally foster a healthy competitiveness.

“All of these ratings push us closer to knowing about hospitals—they move the public and the hospitals forward into a realm of disclosure, which is good,” said the AHA’s Wade. “But for most people the real information they want and need is the place they’re going to be taken to. They’re not thinking about the world’s best—they’re thinking about the hospitals around them.”