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Judith H. Hibbard, Jean Stockard, and Martin Tusler Hospital Performance Reports: Impact On Quality, Market Share, And Reputation Health Affairs, July/August 2005; 24(4): 1150-1160. [Abstract] [Full Text] [Figures Only] [PDF] [Supplemental Exhibit] [Reprints & Permissions]

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Hospital Performance Reports -- Caveat Lector

William B. Lawlor   ( 22 August 2005 )

Hospital Performance Reports -- Caveat Lector 22 August 2005
William B. Lawlor, MBA/Master of Health Services Management Monash University Send letter to journal: Re: Hospital Performance Reports -- Caveat Lector wblaw1{at}student.monash.edu.au William B. Lawlor	Judith Hibbard and colleagues report that making performance-related data available to the public results in quality improvements in the clinical area being reported on. QualityCounts and MedStat, from where they obtain their information, collect and analyze data in an equitable and scientifically valid fashion. However, there are some important caveats their article has left unaddressed: 1. Publication of hospital performance reports and ensuing quality initiatives are a Band-Aid solution to a more serious and endemic problem –- that of a medical culture resistant to change. One need only go to the last issue of Health Affairs in which Anne–Marie Audet and colleagues highlight the long-standing resistance of the medical profession to embracing quality improvement (QI).[1] If hospitals and, indeed, health systems, are to have any chance of keeping future costs manageable, QI needs to be addressed through fundamental cultural change, not simply public reporting. Addressing quality issues through effective, system-level cultural change has been shown to improve hospital efficiency, patient flow, and overall quality. [2,3] 2. Publication of results involving adverse events and subsequent media reporting of them is not without merit -- the mass media is one of the most important sources of health information for the public.[4] However, irresponsible media reporting of adverse events in hospitals, without proper knowledge of the full circumstance, is one of the primary impediments to removing blame culture. Blame culture is a fundamental impediment to the quality improvement the authors profess to seek.[5] Further to the above points: Hibbard and colleagues go to some lengths to mention that public reporting of adverse events can have a significant effect on a hospital's reputation (as if this were a good thing). This in turn affects their ability to raise funds. A high percentage of U.S. citizens are uninsured or underinsured, as highlighted in a number of this issue's articles. One can only imagine the effect such reporting, as endorsed by the author, would have on the safety-net hospitals relied upon by so many Americans. Notes 1. Audet A-M, Doty M, Shamasdin J, Schoenbaum S. Measure, learn and improve: Physicians’ involvement in Quality Improvement. Health Affairs. May/June 2005. Vol. 24 Iss.3; pg. 843, 9 pgs. 2. Brideau L. Flow: why does it matter? Frontiers of health services management 2004. Vol. 20. Iss. 4, pp. 47-50. 3. Zimmerman R. Hospital capacity, productivity, and patient safety –- it all flows together. Frontiers of Health Services Management 2004. Vol 20. Iss. 4, pp. 33-38. 4. Grilli R, Ramsey C, Minozzi S. Mass media interventions: effects on health services utilization. Cochrane Database of Systematic Reviews 3, 2005. 5. Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington DC: National Academy Press, 1999.