As we acknowledge Patient Safety Awareness Week March 14-20, the mission of advancing safety discussions and education in healthcare is more important than ever. One of the most common ways safety in hospitals is measured is through nationally recognized surveys and corresponding reports.
Patient quality surveys and reporting are essential practices in healthcare. Not only does this process keep consumers and purchasers informed with transparent, current data, it’s an opportunity to make the public aware of high standards being met by local hospitals. The data shared by these survey reports also help hospitals pinpoint areas that need attention.
Crystal Barter, Director of Performance Improvement for the Michigan Center for Rural Health, works in quality improvement, mainly with Critical Access hospitals in the state of Michigan. Critical Access status is a federally funded program and designation that helps small, rural hospitals serve residents that would otherwise be a long distance from emergency care. This designation reduces the financial vulnerability of rural hospitals and helps improve access to healthcare. There are currently 37 Critical Access hospitals in the state of Michigan.
No matter the designation of hospital, Barter agrees that attention and education around patient safety should always be of top concern. Quality surveys perpetuate that notion and create transparent communication regarding the matter.
“I think patient quality surveys are a good opportunity for the public to really be aware of the high standards that are being met by their local community hospital,” Barter said. “We do know that rural facilities, particularly in Michigan, provide high quality, patient focused care and these surveys can just be one tool to showcase that and market it to their patients.”
“The surveys also allow for hospitals to really focus on key areas within their facilities to monitor...maybe a specific clinical quality measure, a specific department, and then build upon opportunities in those key areas.”
One of the largest surveys and reports of this kind is The Leapfrog Group Hospital Survey and corresponding Safety Grades. According to their website, The Leapfrog Group is a “nonprofit watchdog organization that serves as a voice for health care consumers and purchasers, using their collective influence to foster positive change in U.S. health care.” Every six months, once in the fall and once in the spring, the group collects, analyzes and publishes data on safety in hospitals nationwide.
Prior to releasing safety grade reports, The Leapfrog Group sends an annual, voluntary survey to hospitals. The safety grade is assigned whether a hospital has completed the survey or not. If a hospital does not report the survey, the safety grade uses data that is publicly available..
Assigning “A” through “F” letter grades to acute-care hospitals nationwide, these grades assess how well hospitals protect patients. Taken into consideration during the grading process are the number of preventable errors, accidents, injuries, and infections that take place at each facility.
In December 2020, several Upper Peninsula hospitals received their fall 2020 Hospital Safety Grade from The Leapfrog Group and The Economic Alliance for Michigan. Out of Upper Peninsula regional hospitals, Dickinson County Healthcare System in Iron Mountain and Upper Peninsula Health System - Portage in Hancock both received “A” ratings. For Dickinson County, this marks the third consecutive “A” rating. Upper Peninsula Health System in Marquette received a “B” and War Memorial Hospital in Sault Ste. Marie received a “C.”
Stephanie Pins, Director of Quality Management/Risk/Compliance at War Memorial Hospital, said The Leapfrog Group survey has usually been geared towards larger hospitals. Because of this, War Memorial has not participated in the survey for the past couple of years. Pins said lack of participation contributed to their "C" grading.
“For a smaller hospital (like War Memorial), it's a lot of work to put towards a survey like that, and we didn't have the administrative resources at the time,” Pins said. “When it comes to patient safety, there are so many different quality scores out there that it can send you scrambling. As an organization, you have to line them all up and see what makes the most sense.”
These reports are most commonly targeted towards consumers and purchasers, but safety grading is important in all areas of health care. While beneficial in a variety of ways, these patient quality surveys are not one size fits all. For smaller hospitals such as War Memorial, surveys like that of The Leapfrog Group have not always made the most sense logistically.
Some examples of other patient safety surveys are IBM Watson, commonly utilized by system based hospitals like Spectrum, and U.S. News, known for being easily digestible by consumers. When specifically focusing on the Critical Access Hospital subset in the state of Michigan, all participate in the Medicare Beneficiary Quality Improvement Project (MBQIP). In this area, Michigan facilities are consistently ranked by the Health Resources and Services Administration as top five in the nation for quality reporting and improvement.
Many larger survey groups, like Leapfrog, use a methodology that is heavily focused on in-patient quality metrics or collection of cardiovascular programs. In some cases, this may lead to fewer rural facilities being eligible to participate due to the services provided.
Barter agrees that oftentimes, rural hospitals may not necessarily align with the methodologies of these large reports. For example, despite being graded a “C” by The Leapfrog Group, War Memorial was recently named one of the top 100 rural hospitals in the country by The Chartis Group.
“A lot of these rural facilities aren't eligible (for quality surveys by larger groups) solely because they have a smaller volume of patients that fit within that specific quality measure,” Barter said.
She added that the gold standard of quality measures is the National Quality Forum (NQR) Stewardship, and they along with industry experts across the nation are working on alleviating the low volume issue in rural areas, but it is still a barrier currently. Due to these changes being assessed by The Leapfrog Group, War Memorial will be participating in the April 2021 Leapfrog Group survey, the first time the hospital has done so in the past few years.
Pins said no matter which avenue quality data is received, it is beneficial to the organization.
“For any survey (we participate in), when the results come out, we look at where our biggest opportunity for improvements are,” Pins said. “Then we get strategic as an organization as far as where we need to focus our efforts and which projects we need to work on.”
Assessing and perfecting patient safety in hospitals is a never-ending task. As Patient Safety Awareness Week comes and goes, important ways to go above and beyond in safety are brought to the table. For Barter, the highest quality patient care starts with a dedicated, consistent, staff and healthy culture of safety.
“Everybody working in the facility has to fully buy-in and embed a culture of safety from within. What that means is day-in and day-out embedding safety behaviors into each department,” Barter said. “That could mean something like making sure all of your staff feel comfortable and safe in speaking up should they see something that looks like it’s out of the ordinary, could lead to a near miss or an event.”
She adds that patient empowerment is the other necessary piece of the puzzle and is something that has become more difficult due to pandemic restrictions on visitors.
“The more that we can involve the patients and their family members in their care, encouraging them to ask questions and really feel like a part of the care team, the safer it is for everyone.”
Patient Safety Awareness Week is March 14-20. For more information on what this week represents, activities you may be able to do to participate, or ways to improve patient safety in general, visit the Institute for Healthcare Improvement.
For questions or comments in response to this post, please email ruralhealth@nmu.edu.