Leapfrog Group CEO Leah Binder seeks more transparency in pediatric care

In an interview with Chief Healthcare Executive, Binder says she’s concerned parents say they don’t know how to report problems. All pediatric hospitals should disclose the results of patient and family surveys, she says.

When it comes to their kids, parents usually aren’t reluctant to speak their minds.

Whether it’s school, sports, music or theater programs, if parents have a concern, they usually share it.

So Leah Binder, president and CEO of The Leapfrog Group, said she’s very concerned that parents are hesitant to bring up concerns about the care of their children in hospitals. In an interview with Chief Healthcare Executive, Binder said she found that the most troubling aspect of the group’s recent report on the pediatric patient experience in hospitals.

“What’s really disturbing about the report remains that parents seem to feel uncomfortable bringing up problems that they perceive in the care of their children,” Binder said.

“They feel uncomfortable when saying something’s not right,” she added. “That’s actually quite dangerous. It’s very important that patients and families feel comfortable speaking up because they’re often the most important line of defense for patients to protect themselves from errors and accidents.”

The Leapfrog Group, a national watchdog organization that reports regularly on hospital safety grades, issued its report on children’s hospitals in late May. Binder talked about the report, and her desire for more transparency in children’s hospitals, in a recent interview. (The story continues after the video.)

Progress in some areas

Even as federal officials are voicing increasing concerns about the erosion of patient safety in hospitals during the COVID-19 pandemic, pediatric care has fared well in many respects, the Leapfrog Group found.

In most areas, such as how well doctors and nurses were communicating with patients and family members, children’s hospitals held steady or even showed a bit of improvement compared to the pre-pandemic period. Hospitals also fared well in terms of keeping parents and guardians informed about the care of their children.

“The pandemic did not seem to impact patient experience reports,” Binder said.

However, parents gave the least favorable responses to questions on preventing mistakes and helping parents or caregivers report concerns. Parents were asked if providers told them how to report concerns or mistakes, and they were also asked if staff checked to confirm the child’s identity before giving medicine.

In this area, 62% of parents and guardians gave favorable responses mid-pandemic, roughly the same as before the pandemic (61.4%). The Leapfrog Group report flagged this result as “a major problem for patient safety.”

“That’s very disturbing in pediatric hospitals,” Binder said. “I do hope that hospital leaders are working on that.”

Binder admitted she isn’t sure why parents aren’t speaking up if they have concerns, since children’s hospitals tend to be welcoming and aim to make parents as comfortable as possible. “It’s surprising that for some reason parents don't feel that level of comfort” in speaking up, she said.

Seeking more transparency

Children’s hospitals should do better when it comes to transparency, Binder said.

While general hospitals are required to report patient satisfaction surveys, children’s hospitals don’t have a similar mandate. Some pediatric hospitals gather feedback from families and share it with the Leapfrog Group, but others don’t, Binder said.

“I think the biggest concern though that I have with pediatric hospitals with regard to patient experience is that not all pediatric hospitals actually do a patient experience survey. And the ones that do it, don’t necessarily publicly report it,” Binder said.

“And that is a big issue. And that’s different from general hospitals which are required to report their patient experience surveys so they’re required to do them.”

The Leapfrog Group has asked the Centers for Medicare and Medicaid Services to require children’s hospitals to conduct those surveys and publicly report them.

“I think the public is entitled to see this data,” she said. “It’s time CMS started requiring public reporting of all hospitals, not just general hospitals.”

While she said there have been calls for CMS to require children’s hospitals to report and release those surveys, Binder said she doesn’t see it happening anytime soon.

She also would welcome children’s hospitals taking the step on their own.

“I think that pediatric hospitals shouldn’t wait for the regulators to tell them to do a survey of their patients to find out how they’re doing,” Binder said.

She is appreciative of the children’s hospitals that share their survey results with the Leapfrog Group.

“The reason we have the data is we ask hospitals to voluntarily give it to us,” Binder said. “We get a good number that do voluntarily give it to us. So that’s a very good sign.”

“There are certainly pediatric hospitals out there that are willing to be transparent and willing to make certain that they know how patients view their experience,” she said. “But not all of them do.”

‘Employers really want this data’

General hospitals collect standardized surveys of patients (the Consumer Assessment of Healthcare Providers and Systems) to get a sense of patient satisfaction.

The surveys relate directly to the quality of care, she argues.

“Patient experience is a very strong indicator of quality outcomes and safety outcomes and it’s really important for leaders and for clinicians within a hospital to make sure they’re doing their job to the benefit of their patients,” Binder said. “How better can they know that than asking their patients?”

Hospitals also gain more knowledge in comparing the results of standardized surveys with other health systems.

Health systems only learn so much, for example, if they find that 90% of patients say they had good communication with doctors. It’s important to know how that compares with other providers.

“Is that good or is that not good? if 90% is lower than average, you know you’re not doing as well as you could,” she said.

Employers, who are investing in the healthplans of their workers, want to get a better sense of the quality of children’s hospitals, Binder said.

“Our employers really want this data. People will shop for children’s health,” she said.

“When it’s your child who is sick or facing a serious challenge in their health, you will go to the end of the earth,” Binder said. “Most parents will just do anything, they’ll sell everything they own to get their kid to the right place.”

Employers are searching for more information on the quality of children’s hospitals, and Binder said they are frustrated they can’t learn as much as they’d like.

“It’s just disappointing,” Binder said. “You’d think that children's hospitals would be transparent. It just seems like they should be.”

Coming tomorrow: Leapfrog Group CEO Leah Binder talks about the need for a greater focus on patient safety in hospitals