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Hospitals improved patient safety in past decade, but much work remains, Leapfrog Group says


The watchdog organization released its fall 2022 Hospital Safety Grades, and it’s the 10th year of the group’s report cards. Hospitals made great strides before the COVID-19 pandemic, but gains have been lost.

Hospitals have made noteworthy progress in keeping patients safe in the past decade, but they can do better, according to The Leapfrog Group.

Leah Binder, president and CEO of the Leapfrog Group

Leah Binder, president and CEO of the Leapfrog Group

The Leapfrog Group, a watchdog organization focused on patient safety, released its fall 2022 Hospital Safety Grades Wednesday morning. Nearly 3,000 hospitals were analyzed in several areas, including infections, medical errors and accidents.

Here’s the breakdown of the fall grades: 30% of hospitals earned an "A," 28% received a "B," 36% received a "C," 6% received a "D," and 1% received an "F.”

This is the 10th anniversary of the safety grades. Health systems have made gains in some areas over the last 10 years, particularly before the COVID-19 pandemic. Hospital-based infections dropped substantially in the years before the pandemic, the group says.

More importantly, there has been a greater focus on protecting patients, said Leah Binder, president and chief executive officer of the Leapfrog Group.

“This is an achievement of the hospital community,” Binder told Chief Healthcare Executive in a phone interview. “Hospital leadership has put more of a priority on safety.”

At the same time, Binder said it’s not time for hospital leaders to declare “mission accomplished” when it comes to patient safety.

“We have some cautious optimism. We think as a country we might be on the right track in addressing patient safety effectively,” Binder said. “We haven’t gotten there. There’s a lot more work to do.”

“We still have a tremendous problem with patient safety.”

The power of transparency

Hospitals have made progress, and much of it is tied to financial incentives from the federal government, Binder said.

The Centers for Medicare & Medicaid Services tie reimbursement rates to patient safety metrics. Hospitals with higher rates of infections or errors can see reduced reimbursements.

Beyond that, the government has shared the findings of patient surveys, and entities like the Leapfrog Group and other organizations are publicizing the findings.

“In the past decade, this is the first time we’ve seen public reporting by facility on safety,” Binder said, adding, “There’s been an explosion of transparency around healthcare.”“That’s the big difference,” she said. “It doesn’t mean public reporting caused this change to happen. Public reporting is just reporting. It galvanized change. It gave leaders some tools they needed for action.”

The gains, especially up until the pandemic, were significant, Binder said.

Central line infections plunged 43% before the pandemic, while methicillin-resistant Staphylococcus aureus (MRSA) infections decreased by 22%, according to the Leapfrog Group.

Hospitals have improved beyond just seeing fewer infections.

“It’s across the board, in both process measures and outcome measures, in infections and never events, to the use of technology effectively, to culture of safety,” Binder said. “We’re seeing patterns of improvement across the board up until the pandemic.”

The COVID-19 pandemic has eroded gains in patient safety, federal officials have said. In an analysis published in the New England Journal of Medicine in February, they outlined sharp increases in infections. While federal officials acknowledge that hospitals encountered unprecedented challenges in the pandemic, they said they were troubled by the reversal of progress in patient safety occurring so quickly.

Hospitals have work to do to restore progress in protecting patients, Binder said.

“It didn’t completely destroy all progress but it dented our enthusiasm about the last decade,” Binder said of the pandemic.

“We didn’t reverse all the progress,” she said. “The bad news is, it definitely hurt the cause.”

Employers are saying they’re frustrated with the higher costs of healthcare. They are telling the Leapfrog Group, which was founded by large employers and other purchasers, that they are increasingly frustrated with patient safety issues affecting their workers, Binder said.

“Employers are exceptionally frustrated,” Binder said. “That’s only going to be compounded as they see the premium increases that are coming.”

In a tight labor market where companies are trying to hold onto their workers, employers are demonstrating less patience for hospital infections or errors that are hurting their employees. Companies are also increasingly demanding more transparency in hospital safety.

“They’re very worried about safety,” Binder said. “I’ve never seen employers so engaged around this issue before.”

Improving patient safety

Hospital and health system executives can help improve patient safety by paying more attention to their data on infections and accidents, Binder said. Leaders should pore over measurements of patient safety.

“CEOs need to memorize their own data,” she said.

“They need to watch it every day,” Binder said. “It’ll make them a better health system. It’ll create a better workforce.”

When health system executives closely watch safety data and push for improvements, “it’ll have a ripple effect on everywhere else.”

“I think there's an opportunity for leaders to make a real difference in every aspect of their organization,” Binder said.

In an increasingly competitive healthcare environment, hospitals that improve patient safety measures can improve their standing in their market.

“This is an opportunity for health systems to tell their story in the community,” Binder said.

Binder also characterized improving patient safety as a good step in retaining workers. Healthcare systems are struggling to keep their own workers in a labor shortage, and hospitals that are falling short in protecting their patients may lose good workers.

”It is a workforce issue, it is an issue of the safety and quality of the care,” Binder said.

“People want to work at a place that makes it easy for them to be excellent,” she said. Good doctors and nurses don’t want to stay at hospitals where safety isn’t the highest priority.

“These are some of the smartest, most competitive people in the country who go into healthcare,” Binder said. “They want to make people healthier.”

“By focusing on safety, leaders convey they are going to give their people everything they need to excel, and that’s where people want to work,” she said.

Looking at the grades

Well over half of the hospitals examined (58%) received either an “A” or a “B.” Only a small number of hospitals received a “D” or “F,” and those hospitals tend to improve fairly quickly, she said. “It is sadly motivational to them,” she said.

The sizable group of hospitals that only received a “C” are capable of doing better, and there’s a clear gap between them and the hospitals that are performing better, she said, “I’d like to see the ‘C’ hospitals step it up,” she said.

For the first time, New Hampshire emerged as the state with the highest percentage of hospitals with an “A” grade. In the spring rankings, the Granite State ranked 25th, but vaulted to the top spot in the fall, with about 54% of its hospitals earning an “A.”

“That was exciting,” Binder said.

Florida landed in the top 10 states with “A” hospitals for the first time. “We have seen a lot of effort in Florida to address patient safety,” Binder said. “They’re really gaining traction.”

However, Binder said she’s perplexed by New York’s low ranking among states with “A” hospitals, coming in 39th. About 13% of New York’s hospitals earned an “A” grade.

She said it’s especially troubling because so many healthcare professionals get their training in New York.

“I’d like to see New York state up its game. Fast,” Binder said.

Conversely, New York can look across the state line to one state doing very well: New Jersey. The Garden State ranked 6th, with 47% of hospitals getting an “A” grade. And New Jersey typically lands in the top 10, Binder said.

Looking at New Jersey, she said, “Patient safety matters to people, and you can see the result.”

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