Hopkins is no slouch
Pronovost, an intensivist whose checklist is credited for dramatic reductions of central line and other hospital-acquired infections, notes that Hopkins is no slouch in these same measures. In fact, he says, it would have made the list except for two or three measures that didn't reach 95%, but instead were at 91% or 92% for a month or two.
But Hopkins now publicly reports some 250 measures to external agencies, and Pronovost says it works hard at improving all of them.
"We have this discussion every day," he says. If you're at 92% or 93%, and you have to hire a nurse to assure compliance to get to 95% or 98%, is that the best place to spend your nickel?" Pronovost says that a much better use of effort should be spent "trying to reduce patient harm, not to trying to get listed on a scorecard."
Joanne Conroy, MD, chief healthcare officer for the 350-member Association of American Medical Colleges, agrees. "The Joint Commission's methodology makes invisible a lot of hospitals that perform at a very high level, but they didn't quite tip over 95%."
She explains that the Commission selected measures for common conditions that all hospitals see, like pneumonia or heart attack. For teaching hospitals, that's part of what they do, but a bigger share of their workload is made up of extremely sick, very complicated patients referred to them because other hospitals won't take them.
"People send us patients who might need a hip replacement, but who are also significantly obese, maybe have COPD, cardiac disease and other conditions that make doctors in community hospitals less willing to take."