Last month, Newsweek released their prestigious league table, the World’s Best Hospitals 2021, in which the Mayo Clinic in Rochester took the coveted top spot. Unsurprisingly, the top ten featured regulars including the Cleveland Clinic (at number 2), Johns Hopkins (at number 5) and Sheba Medical Centre (at number 10), culminating in a list of the best, and best-known medical care facilities across the globe. In Newsweek’s UK version of their list, St Thomas’s Hospital, London tops the table, followed by University College Hospital, London and the Royal Victoria Infirmary, Newcastle-upon-Tyne.
Newsweek aren’t the only ones to get in on the league table act. Watson Health and IBM have also just released their own ‘100 Top Hospitals’, an in-depth assessment of US hospitals which is now in its 28th year, and there are many more.
“I like the concept of league tables in healthcare, not because I think they represent an absolute benchmark for healthcare quality, but because they open the discussion about what constitutes quality in service delivery and how we should measure it” - Dr Peter Mills, European Medical Director, Cigna International Markets.
So, what can we really take from these types of league tables? With different organisations each applying their own, disparate measures of quality and excellence, it’s important to take a step back and reflect on the metrics being used to make these assessments. What’s more, we need to think carefully about whether these measures conform not just to contemporary wisdom about what makes a good hospital, but also how they sit alongside other, less quantifiable priorities such as organisational culture, patient experience and commitment to quality improvement. In an outcome-driven world, what does being ‘the best’ really mean?
Of course, there are substantial similarities in the way that judgements of excellence in healthcare are made: Newsweek’s rankings are derived by collating data from surveys of medical experts, patient experience data and medical performance metrics, whilst the IBM league table takes into account a similarly broad range of data including patient readmissions, mortality rates, extended care quality, operational efficiency, financial health and patient experience.
Although they use different tools, most league tables will collect and use data which relates to similar outcome measures, combining objective data with subjective information derived from patient and clinician surveys.
But quality in healthcare is about more than data: whilst data and rankings are an important part of the picture, they are still only a part.
According to Newsweek’s Editor in Chief, the hospitals named in its list “stand out for their consistent excellence, including distinguished physicians, top-notch nursing care and state-of-the-art technology.”
But we all know that it’s simply not possible for all hospitals to attract the most ‘distinguished’ physicians, ‘top-notch’ nurses, or to purchase the latest ‘state-of-the-art’ technology. What’s more, the best-performing hospitals will inevitably continue to attract the best talent, be better funded and probably achieve better outcomes for patients.
In the absence of these advantages, what can other healthcare providers do to build on their service, move up the rankings, attract better talent, enhance profitability and - ultimately - improve the patient experience?
One key indicator of quality in healthcare - and one which is almost impossible to measure - is an organisation’s commitment to driving positive change. From the top to the bottom of league tables, a dedication to quality improvement can significantly enhance the quality of service over time. This commitment can be hard to measure, but is reflected in efforts to:
Build capability and confidence in managers and staff
Maintain a positive, inclusive and supportive organisational culture
Implement quality improvement strategies which are actionable and sustainable
Develop positive cultural change across the organisation
Look after staff and show strong leadership, ensuring that staff are active collaborators in the quality improvement journey
One of the benefits of league tables in any sector is that by demonstrating which organisations are ‘doing it well’, those organisations which are performing less well have a clear model on which to base future plans for their own service delivery. But in order for this strategy to succeed in driving up standards across the board, there has to be a clear, transparent and actionable strategy for improvement.
Within the healthcare sector, this strategy must focus not just on objective measurements of success and efficiency, but also on more nuanced markers of quality such as commitment to improvement, organisational culture and the organisation’s ongoing journey towards better quality care.
League tables have an important role in helping us assess quality and make informed choices, but they are not the only measures of quality and excellence that matter.