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Charges of bias and inappropriate behavior flew between Naperville-based Edward Hospital officials and members of a Illinois regulatory board just minutes after the board for the third time in five years rejected Edward's request to build a hospital in southwest suburban Plainfield. Edward had requested permission to build a 130-bed, $242 million facility on 60 acres it owns. Edward already operates an immediate-care center there, and won permission from the Illinois Health Facilities Planning Board to upgrade a portion of that center to a free-standing emergency room. But the board denied Edward's request to build a hospital on the site, saying there are more than enough hospitals nearby.

HealthGrades this week released its annual study of hospitals it says are in the top 5% in the nation as measured by mortality and complication rates. According to HealthGrades, Medicare patients at these 270 hospitals—out of more than 5,000 hospitals nationally—are on average 27% less likely to die and 8% less likely to suffer a major complication.

Robinson Memorial Hospital in Ravenna, OH, 35 miles southeast of Cleveland, has made HealthGrades list of Distinguished Hospitals for Clinical Excellence. Robinson, a community hospital with 150 staffed beds, serves the 12,100 residents of Ravenna and the 142,585 or so souls living in Portage County.

Robinson's rise to the top was no accident, but the result of a conscious decision nearly a decade ago to be among the best. Deborah Small, vice president of patient care services and CNO at Robinson, says the competitive environment for hospitals in northeast Ohio, which she calls a "hospital Mecca," forces them to perform well. "If we don't, our clients can seek hospital care elsewhere," she says.

To determine the top hospitals, HealthGrades analyzed nearly 41 million patient records from CMS for fiscal years 2005, 2006, and 2007 for 26 medical procedures and diagnoses at all of the nation's nearly 5,000 non-federal hospitals. HealthGrades estimates that 152,666 lives may have been saved and 11,772 major complications avoided during the three years studied, had the quality of care at all hospitals matched the level of those in the top 5%.

Robinson's methodology for quality care reads like a how-to manual for hospital success. The community hospital has emphasized collaborative management of patient care and evidence-based medicine across all disciplines. "We have a strong service excellence program, and the service starts at the front door. We work at discharge planning at the beginning of your admission," Small says.

That service includes a proactive approach to providing care. "We work a lot with community and preventive medicine," she says. "Our patients may not be as sick as someone else who comes in because they've done all the right things. They've taken all of their medications. They understand what they are taking and what to take it with and how to take it."

A chronic pulmonary patient, for example, would be given a planning guide to manage their daily activities so they don't exhaust themselves and trigger a respiratory event. "We provide very good education up front," Small says.

Robinson, which is also recognized as a magnet hospital by the American Nurses Credentialing Center, encourages dialogue and communication with its staff of approximately 1,600. "Because we have so many disciplines providing care at the bedside, it's important to communicate efficiently and effectively and get the right message across every time," Small says.

Robinson's staff uses the military's SBAR method (Situation, Background, Assessment, Recommendation) for communicating patient information. The hospital's physicians have been asked to develop standardized hand-off communication procedures to expedite and improve the transition among caregivers. "That takes a little more time because physicians communicate differently," Small says.

Professional development is also emphasized at Robinson, where employees are recognized for their strengths and not just reminded of their weaknesses. "Everybody brings something to the table, and finding out what that something is is a challenge. But when you find it, it's amazing what people do with those talents," Small says. "We're not always looking for the things that aren't done well, but looking for the things that are done very well. You tell the housekeepers what a great job they're doing with the rooms and all of a sudden the rooms look even better."

When Robinson finds talented patient-care technicians, for example, they're offered professional development opportunities that can include training to become a registered nurse. The community hospital offers tuition reimbursement for healthcare-related continuing education.

Robinson's hospital foundation holds an annual gala, with the funds used to send staff to professional conferences and seminars. "We ask them to bring back to our environment what they've learned and share it with the rest of the staff," Small says. "You don't generally find your staff going to outside seminars and conferences—first, because they can't afford it or afford to take the time off, and second, no one tells them that they are good enough to go."

The emphasis on communication and employee development has also positively affected turnover, which was 5.1% among nursing staff in 2008 and 9.3% hospitalwide.

Despite the organization's achievements, Small says Robinson Memorial can't afford complacency. "You continually raise the bar. Good is never good enough," she says. "We are constantly looking for improvement processes in everything we do."