Transparency in Quality Ratings: Making Sense of the Buzz

Transparency in Quality Ratings: Making Sense of the Buzz

When you buy a car, or even a new flat screen TV, you probably do quite a bit of research, comparing prices, user reviews and the exact specs of the different models you’re considering, in an effort to purchase a high-quality product. Yet consumers have traditionally had a very different experience when it comes to “shopping” for a high-quality healthcare provider—there has, in the past, been little to go on other than the personal experiences of friends and neighbors.

Along the way, media and public interest groups have attempted to rank the nation’s best and worst hospitals. Yet a study in Health Affairs revealed there is no consensus among the leading hospital rating services, which include: US News & World Report, HealthGrades, Consumer Reports, and the Leapfrog Group. Each of these entities scores the same hospital very differently. The Centers for Medicare & Medicaid Services (CMS) also rates hospitals, publishing the information gleaned from its HCAHPS survey on the consumer-oriented Hospital Compare website.

So what’s a consumer to do? Clearly, a greater volume of data isn’t the answer. Instead, patients need more reliable data, organized in comparison-friendly way, to guide their decision-making.

The most promising recent trend in the quest for transparency in quality ratings is for hospitals to voluntarily publish the results of their own internal quality measures. As the trend catches on, this kind of reporting may someday become mandatory.

University of Utah Health Care is credited with being the first healthcare system in the nation to make internal quality data public, including feedback from actual patients—both negative and positive. You can read the fascinating, engagingly written story of how visionary leaders came to make this bold move, after weighing the pros and cons and overcoming opposition, online (or download a PDF to read later). Physicians in particular worried about the potential fallout of publishing negative comments online:

Some feared one or two negative comments would sink their practice. And they worried that only the most disgruntled or the most pleased would post reviews, skewing the data. To counter that, University of Utah decided to only publish the reviews of doctors who have worked six months within the system and accumulated at least 30 surveys. That’s far more than found on other “shop-a-doc” sites, making it ring truer for consumers, who are adept at sifting through and weighing the opinions they read.

Today, University of Utah Health Care professes to be pleased with their new culture of transparency and the way it has helped to drive quality improvements. Other health systems have followed suit and have started publishing actual patient feedback—these include Stanford University Medical Center, Wake Forest Baptist Health, the Cleveland Clinic, and University of Pittsburgh Medical Center.

So why should nurses care about transparency of quality ratings? The most obvious answer is that your professional ethics require you to advocate for your patients, and that patients need data about quality to be effective partners in their own care. Research shows that more informed, engaged patients often have better outcomes. Transparency may also be a mechanism for improving nursing job satisfaction as quality ratings expose understaffing as a driver of pressure ulcers, falls, infections, etc. Skilled nursing care is every bit as important to patients as the quality of the surgeons and physicians that treat them.

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