Each year more than 1,000 hospitals voluntarily complete an extensive nine-part survey that they hope will lead to them being named to The Leapfrog Group's top hospital list.
The survey, launched in 2001, focuses on four critical areas of patient safety: the use of computer physician order entry (CPOE) to prevent medication errors; standards for performing high-risk procedures such as heart surgery; protocols and policies to reduce medical errors and other safe practices recommended by the National Quality Forum; and adequate nurse and physician staffing.
Hospitals are also measured on their progress in preventing infections and other hospital-acquired conditions and adopting policies on the handling of serious medical errors. Criteria are weighted, value scores are applied, and then the hospitals face the toughest standard.
"We ask ourselves where we would send our children," Leah Binder, Leapfrog Group CEO, told HealthLeaders Media.
Hospitals that participate in the Leapfrog survey include academic medical centers, children's hospitals, and community acute care hospitals in urban, suburban, and rural settings. This year 65 hospitals made the cut and earned The Leapfrog Group's annual "Top Hospital" designation.
Virginia Mason Medical Center in Seattle has made the list six times.
The 336-bed medical center fully meets Leapfrog standards in five of seven patient safety ratings:
- Reducing in-hospital injuries
- Preventing medical errors
- Managing serious errors
- Maintaining appropriate ICU staffing
- Reducing preventable medical mistakes
Virginia Mason has made some progress in meeting Leapfrog standards for reducing pressure ulcers and has made substantial progress in meeting the standards to reduce ICU infections.
In addition the medical center fully meets Leapfrog surgical quality and cost standards in seven of nine treatments, including heart bypass surgery and pancreatic resection. It has made substantial progress to meet the standards for aortic valve replacement and heart attack treatments.
In an e-mail exchange, Gary Kaplan, MD, chair and CEO of Virginia Mason, explained that its focus on Leapfrog indicators began about 10 years ago, when The Boeing Company became the lead employer for The Leapfrog Group's roll-out in the Puget Sound region.
The medical center was already looking at new management models to help improve its healthcare delivery system and improve quality. Boeing used the Toyota production system, which and Kaplan and his team adapted to healthcare.
Similar to the Toyota system, the Virginia Mason production system is based on eliminating waste—anything not having value as defined by the customer. "We realized that our systems weren't designed for the safety and convenience of our customer, the patient, but based on the preferences of our providers, managers, and technicians and those of us working in healthcare," explained Kaplan.
He added that "the Leapfrog Group became an early priority because its measures provided tangible evidence of both performance and improvement over time, and because the pillars of the Virginia Mason production system and The Leapfrog Group are complementary."
In a November 2011 speech before the U.S. Senate's Committee on Health, Education, Labor and Pensions, Kaplan noted several organizational and departmental improvements since implementing the VMPS, including:
- Saving $11 million in planned capital investment by using space more efficiently.
- Reducing inventory costs by $2 million through supply chain expense reduction and standardization efforts.
- Reducing labor expense in overtime and temporary labor by $500,000 in one year.
- Reducing professional liability insurance 59% from 2004 to 2010.
- Improving medication distribution from physician order to availability for administration from 2.5 hours to 10 minutes, and reducing incomplete inpatient medication orders from 20% to 40% to less than 0.2% through process improvement and CPOE implementation.
In 2010 The Leapfrog Group recognized Virginia Mason and the University of Maryland Medical Center as The Leapfrog Group's "Top Hospitals of the Decade" in recognition of their achievements in reducing medical errors and their innovations in patient safety and quality.
The Leapfrog hospital survey is adjusted each year to reflect new research about quality, safety, and efficiency measures. The 2011 survey added a section on the patient experience. Changes under consideration for the 2012 survey include the removing hospital-acquired pressure ulcers and injuries measurements and expanding the list of ICUs for which hospitals will be asked to report their rates of central line associated bloodstream infections.
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Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
