A hospital is subpar, or "lousy," when it fails to improve. It's not a matter of bad luck.
John Griffith, MBA, FACHE, a professor in the department of health management and policy at University of Michigan's School of Public Health, penned an op-ed for Health Affairs exploring the idea of "lousy hospitals." According to Mr. Griffith, a hospital is lousy because it repeatedly fails to improve, not because it meets a streak of bad luck.
Mr. Griffith's understanding of performance centers on the Malcolm Baldrige Quality Award, for which he previously acted as an examiner. First awarded in 1988, the Baldrige Award is the only formal recognition of performance excellence for public and private organizations across several sectors given by the U.S. president.
To earn the award, organizations take what has been dubbed the "Baldrige journey," an improvement process that can take several years. The award process itself is rigorous, with a 50-page application and thorough review and scoring by a team of trained judges. Nearly half the score is based on results for care quality, patient satisfaction, employee satisfaction and finances.
Mr. Griffith recommends patients use publicly availabledata about care quality and patient satisfaction to avoid the "lousy" hospitals, or those at the lowest ranks for mortality, safety and readmissions. And for the board members of those hospitals? Mr. Griffith refers to a concise quote from an American business legend. "The proper action for the governing boards of these institutions is to choose from one of only three options initially described by [retired] GE CEO Jack Welch: 'fix it, sell it or close it.'"
But before they improve, sell or close, hospitals will likely share some excuses for subpar performance. Mr. Griffith expanded on the three he encounters most often.
"Our patients are sicker." Measures are carefully built to adjust for most patient variation, reducing the credibility of this excuse. If a hospital truly believes this is an issue, Mr. Griffith presses them harder on it. "The right answer to 'Our patients are sicker' is, 'Really? Have you documented how that is so? We should report that to the measurement authorities for further study.'"
"We're short of staff." This goes back to a chicken or the egg problem. Mr. Griffith says a hospital is short of staff because it is lousy, not the other way around. When hospitals make an honest effort to improve, they can attract and retain better staff. "Baldrige recipients and Magnet hospitals claim that they are 'great places to get care' because they are 'great places to give care,'" he says.
"We aren't paid enough." Many hospitals operate in challenging economic environments, and a handful of these have really eliminated this has a persuasive excuse. "Hospitals such as AtlantiCare in Atlantic City [N.J.], Henry Ford [Health System] in Detroit, Sharp [HealthCare] in San Diego, and North Mississippi [Medical Center] in Tupelo all work in challenging economic environments. They are all Baldrige winners," wrote Mr. Griffith.