The 620 top performers represent about 18 percent of the country’s more than 3,300 accredited hospitals that report the relevant data and are not ranked in any particular order. Many of the top performers were small community hospitals rather than big academic medical centers.
One reason, Chassin said, is that large hospitals tend to have more patients with more complicated conditions. For those facilities, he said, “It is more difficult to achieve this kind of consistent excellence.” Still, he said, those institutions also have more resources to devote to improving their performances.
Other Washington area hospitals that failed to make the top performers list either year included MedStar Georgetown University Medical Center, MedStar Washington Hospital Center, George Washington University Hospital, Suburban Hospital and Inova Fairfax Hospital.
Executives at those facilities said they improved in many areas and would work harder to do even better. Some of the hospitals fell short on a single measure by less than one percentage point. Other scores were well below 90 percent on an important gauge.
Many local hospitals scored lowest on consistently providing appropriate pneumonia and flu vaccines.
Smaller hospitals have time to have their staff review patient charts in real time to make sure everything gets done, Pronovost said. “If I have 10 beds, it’s not that much work.” he said. But for a large hospital such as Hopkins, administrators have to decide whether it makes sense to have “six nurses do that or are there better ways to spend the time of six nurses.”
Still, he said, Hopkins would adopt some real-time review of charts for measures on which the hospital didn’t perform well.
Holy Cross’s position on the list has boosted the profile of the 448-bed facility, which is part of Trinity Health, a Catholic hospital system based in Michigan. Other hospitals, locally and elsewhere, have come looking for “our secret sauce,” said Yancy Phillips, the hospital’s vice president of quality and care management. Inova Fairfax, for example, is modeling some of its practices after Holy Cross, executives said.
Phillips credits three factors for the hospital’s success: intensive review of patients’ charts, an electronic records system and a leadership focus on quality. The hospital has four staff members whose main job is to scour charts, often virtually through the hospital’s electronic medical records system, to make sure all necessary steps have been taken.
The hospital also put in place a daily noon teleconference during which doctors, nurses and nurse managers go over the cases of patients whose treatments are being measured.