More Facilities Receive Leapfrog's Top Hospital Recognition

By Debra Wood, RN, contributor

January 8, 2013 - More hospitals than ever earned recognition from The Leapfrog Group as the nonprofit champion’s Top Hospitals ranking for 2012 included 13 rural hospitals, 67 urban hospitals and 12 children’s hospitals.

Leapfrog Group CEO Leah Binder
Leapfrog Group CEO Leah Binder said nurses have a real role to play in expanding the level of transparency in this country and improving the safety and quality of hospital care.

“Luckily, the number keeps going up,” said Leah Binder, president and CEO of The Leapfrog Group in Baltimore. “We set a high bar, and more hospitals than ever have made it above that bar.”

The Top Hospitals list recognizes facilities delivering the highest quality care by preventing medical errors, reducing mortality for high-risk procedures like heart bypass surgery, and reducing hospital readmissions for patients being treated for conditions like pneumonia and heart attack.

This year, in addition to meeting Leapfrog’s quality and resource use standards, winning hospitals also had to be among the 790 hospitals to earn an “A” from Leapfrog’s newest initiative, the Hospital Safety Score, if they met eligibility criteria to receive a grade.

Also in 2012, St. Vincent Indianapolis Hospital became the first facility in Indiana to achieve the Top Hospital designation. 

Leapfrog Group began the rural hospital category about four years ago; only a few made the list again this year.

“Twenty percent of America lives in rural areas, so this is not a population we should be ignoring,” Binder said. “They need good hospital care, just like everyone else, and the rural hospitals are showing some leadership.”

Despite 92 hospitals succeeding in the quest to meet the standards, Binder said, “We have a long way to go as a country.”

What does it take to earn a Top Hospital ranking?

The Leapfrog Group survey focuses on three critical areas: how patients fare, resources used to care for patients and management practices that promote safety and quality.

“Leapfrog holds hospitals to a fixed set of defined and transparent standards that are extremely high, and only the hospitals that meet those standards earn the distinction,” Binder said.

The organization measures the number of hospitals using electronic medical records and computer provider order entry (CPOE).

“We are seeing improvements in adoption of CPOE, which cuts errors by 75 percent or more, depending on the study,” Binder said.

Ninety-eight percent of the orders entered at Sinai Hospital of Baltimore are placed electronically, said Tina Gionet, RN, MS, the hospital’s patient safety officer. Electronic systems also help with collecting quality data, which it shares with staff.

But it takes more than technology to create a safe environment. It takes people and a culture conducive to change and always striving to do better.

Dave Tan, RN, MSN, emphasized the importance of organizational culture
Dave Tan, RN, MSN, emphasized the importance of organizational culture in achieving quality and safety goals.

Children’s Hospital of Los Angeles is one of a dozen pediatric facilities named as a Top Hospital this year. Dave Tan, RN, MSN, supervisor of quality improvement at Children’s Hospital of Los Angeles, attributes that success to a culture supporting collaboration and curiosity. 

Chris Boese, RN, MS, NE-BC, vice president of patient care services at Regions Hospital in St. Paul, Minn., credits a positive culture and good collaboration among physicians and other members of the healthcare team. The hospital’s academic environment prompts open discussions and accepts questions.

“We’re also transparent with data, which engenders a little competition to want to be the best and be recognized,” Boese said. “Nurses are aware of the quality initiatives we are doing and their roles.”

Robert Wood Johnson University Hospital in New Brunswick, N.J., also uses a multidisciplinary approach and shares its performance metrics with staff, said Mary Jo Kelleher, RN, MSN, director of quality data management at RWJ University Hospital, who reported full leadership support and managers who ask how they can help staff achieve quality and safety goals. 

“They applaud progress, and they are interested in what they can do to move the needle forward,” Kelleher said.

Gionet agreed, saying, “The key issue is having leadership support and buy-in,” adding, “And nurses are integral to safe practices.”

Leapfrog Group began giving hospitals full credit automatically if they have achieved Magnet status.

“The safest hospitals are the ones that deploy nurses most appropriately,” Binder said. “We were impressed with Magnet requirements and thought that was something to call out, given that most of what happens to a patient in a hospital is delivery of nursing care.”

Nursing’s role in performance improvement

Nurses care for patients throughout their stay and other studies have shown associations between better staffing and work environments and improved safety. Binder said that nurses are aware when hospital environments are not safe, and they often feel frustrated when changing dangerous practices does not appear to be a priority.

At Regions Hospital, nurses serving on practice councils lead efforts to improve safety and conduct process improvement initiatives. They can suggest and try different things.  

“Our success lies in pushing out and having front-line staff lead the initiative,” Boese said. “We have found that to be an effective structure.”

Children’s Hospital of Los Angeles also employs a shared-governance model and heavily involves front-line staff in its quality improvement efforts. They then report results up to the level of the board.

“We have empowered them to take ownership of performance improvement,” Tan said.

Tactical improvements

Designated Top Hospitals have developed and deployed multiple improvement strategies, which they attribute to helping them achieve the honor.

Switching to electronic event reporting has increased the number of near misses reported, enabling the Children’s Hospital Los Angeles to review those events, learn from them and take steps to prevent something similar from occurring again.

Robert Wood Johnson University Hospital has developed standard order sets, for instance admission orders that include applying sequential compression devices to a woman about to undergo a Cesarean section. They also established Foley catheter-removal protocols, so nurses do not need to wait for an order, thereby allowing them to be removed sooner, reducing the risk of infection.

“It gives nurses a sense of autonomy,” Kelleher said. “They can follow protocols and use their clinical judgment.”

The New Jersey hospital’s nurses continually assess new products and stay abreast of new procedures and best practices through information kept on the organization’s intranet. Nurses conduct safety huddles at change of shift and pass along safety issues to watch for to the nurse assuming responsibility for each patient’s care.

Sinai Hospital nurses use teach-back techniques or a return demonstration when educating patients to ensure each person truly understands what is being taught.

Multidisciplinary rounds at Regions Hospital allow nurses to speak up and help keep patients and families, as well as staff, abreast of goals and care plans.

These recognized hospitals do not rest on their laurels. They continually seek to do better. All are keeping their eye on the ball to ensure they remain a Top Hospital in 2013.

“This is a window of good news,” Binder said. “We’re hopeful it’s a sign of an accelerating trend toward safety and quality.”