Upsets and Cinderella stories: What March Madness and hospital rankings have in common

The first weekend of the NCAA Tournament is complete, and despite my best efforts, it's safe to say my bracket is pretty much busted.

Upsets abounded in the round of 64 and continued in the round of 32 in this year's tournament. No. 1 Villanova couldn't catch up to eighth-seed N.C. State. No. 2 Virginia was ousted by Michigan State, a tough seven seed.

And just as there were surprises, other games went as expected. Namely: Kentucky continued dominating, extending its perfect season.

To be sure, upsets happen every year — each tournament has its own special "Cinderella story." Who could forget Florida Golf Coast University in last year's tournament, when it became the first 15-seed team to win two games in the Big Dance? Some teams are just better conditioned and prepared to play than others come game day.

But some upsets could be telling that the seeding process for the Tournament could use some change. Each year, the NCAA Men's Division I Basketball Committee — made up of 10 members who spend "countless hours evaluating teams during the regular season," according to the NCAA website — chooses teams, then ranks, seeds and divides them into four regions on a bracket. If a team doesn't win its conference tournament, its post-season fate is entirely in the hands of these 10 men and women. Fans are hardly ever completely happy with the committee's choices.

"The committee failed again," Paul Klee, a sports reporter with the Colorado Springs Gazette, wrote after Selection Sunday. "It fails every year."

Complaints range from teams that get snubbed (Mr. Klee was pleading the case of Colorado State) to how a particular team is seeded to how teams are arranged on the bracket, among others.

While all of this uproar over rankings is happening in the college sports world, it is simultaneously occurring in another industry: healthcare. Though it's not a perfect analogy since the stakes are much different, the choosing and ranking of teams by the selection committee is similar to how various rating systems in healthcare select hospitals.

A study in Health Affairs found four hospital rating systems — U.S. News & World Report's Best Hospitals, Healthgrades' America's 100 Best Hospitals, Leapfrog's Hospital Safety Score and Consumer Reports' Health Safety Score — have very little overlap when it comes to determining which hospitals are "best."

This is largely because each rating system "uses its own rating methods, has a different focus to its ratings and stresses different measures of performance," according to the study's authors. That could leave patients confused as to where they should turn for information and where to seek care — just as the selection committee's choices leave many coaches, teams and fans feeling perplexed nearly every year.

Since the Illini (my alma mater and the team I follow most closely) didn't get to dance this year, I chose my bracket based on little real knowledge of the teams in the field and how they look on the court. I used some outside help (namely data journalism site FiveThirtyEight and some good old fashioned gut instinct) but mostly I chose based on seeds.

Like hospital rankings, basketball seeds shape our expectations. We expect to see a higher caliber performance from a three seed than a 14 seed, but that didn't stop UAB from taking down Iowa State this year. That's when factors like coincidence, luck, coaching, home-court advantage and an array of other characteristics come into play.

Similarly, we as patients expect higher-ranked hospitals to perform better than their lower-ranked counterparts. But then concerning events, such as major infection outbreaks, come out of well respected, highly ranked institutions like Cedars-Sinai Medical Center in Los Angeles and Ronald Reagan UCLA Medical Center. Hospital quality rankings, as methodological and data-driven as they may be, cannot account for everything.

That's not to say that the seeding system is fatally flawed, or that patients shouldn't look into quality rankings before seeking care — it's just that perhaps patients, and fans, need to do independent research looking into many sources before making a final choice. If you do take rankings seriously, take them with a grain of salt, as well.

In the healthcare arena, at least, patient research may soon be getting easier. During her speech at the American College of Healthcare Executives Congress on Healthcare Leadership, Christine Cassel, MD, president and CEO of the National Quality Forum, said achieving greater consistency and rigor in consumer information is one of the main tasks facing the industry.

And even though it's impossible for every hospital to be No. 1 in the nation or even its region — just like it's impossible for every NCAA basketball team to be a No. 1 seed — the overall national push to improve care quality in hospitals across the nation could mean that soon patients won't have to worry if the care they're choosing is high-quality. It will just be a given.

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