Do hospital rankings matter?

Sree Bhagwat in the lobby of Boston Children's Hospital.
Bhagwat in the lobby of Boston Children’s Hospital

Everyone who works in health care is familiar with U.S. News and World Report’s annual Best Hospitals rankings. But the methods behind the numbers can seem complex and mysterious, even secretive. What do rankings really tell us about the quality of health care at various institutions? Are they even helpful? Do they impact care?

Sree Bhagwat, a senior marketing analyst at Boston Children’s Hospital who manages the hospital’s data collection and reporting to U.S. News, says “yes.”

“It’s not just about competition,” says Bhagwat. “It’s about improving the standards of health care everywhere. The rankings process reveals important metrics that can drive improvements in national health care. Data points are driven by expert clinicians who serve on the numerous U.S. News committees.”

U.S. News data metrics: A breakdown

It’s not just about competition. It’s about improving the standards of health care everywhere,” says Bhagwat. “The rankings process reveals important metrics that can drive improvements in national health care. The U.S. News Best Children’s Hospitals rankings include more pediatric medical centers than any other national rankings organization.

For the 2017-2018 rankings, a total of 187 centers underwent the rigorous survey and inspection process that analyzes the interplay between structure, process and outcomes measures. Data collection, measurement processes and survey questions are evaluated and refined every year. The following is a breakdown of key points of interest:

  • Structure refers to hospital resources directly related to patient care. Examples of measures in this category are nurse-to-patient ratios, specialized programs and services, and externally recognized certifications.
  • Process refers to overall rendering of diagnosis, treatment, infection prevention, patient education and compliance with patient safety standards. A large part of this measure is also determined via a reputational score, based on an annual survey of board-certified physicians. This year’s sample included 9,363 members of the Doximity physician registry and 1,500 non-members.
  • Outcomes refers to not only survival but functional success in cases such as cystic fibrosis. The metric also tracks adverse events such as bloodstream infections and failure of transplanted organs.

Can rankings impact care?

Bhagway asserts that Boston Children’s has considered changes to clinical practice based on data reported by U.S. News, citing the following examples:

Neonatology

  • The U.S. News survey shed light on a way the neonatology unit could improve its documentation of accidental extubations. The department was able to report that it conducts a mini root cause analysis (RCA) within twelve hours of one of these events. A mini RCA is a standardized, documented review to determine the cause of a problematic event and outline possible solutions.

Endocrinology

  • U.S. News lists a number of elements that should be incorporated into a patient’s clinical summary after a visit to a pediatric diabetes program. Boston Children’s added behavioral goals to patients’ clinical summaries based on this feedback.

Flu shots

  • By requiring many specialties to report the number of their patients who had received a flu shot, U.S. News influenced hospitals to identify additional improvements that could be made to address certain public health initiatives. “We realized our medical records didn’t have a standardized way of documenting when a patient received a flu shot outside of the traditional primary care setting, such as at a pharmacy’s clinic,” says Bhagwat’s colleague Jennifer Draffen. “Although our patient data collection process is rigorous, we made a concerted effort to improve our documentation — and exceeded expectations.”

Comparison to other top hospitals inspires a culture of constant improvement. The large-scale, extremely detailed investigation conducted yearly by U.S. News offers all participating institutions the chance to identify potential areas where they can improve. “Every year the data are changed and refined,” says Bhagwat.

Get the 2017-2018 pediatric hospital rankings from U.S. News.