Pumpkin Wars and Hospital Ratings

Last weekend my husband, Bret, and I traveled to Keene, New Hampshire, to visit our daughter, Annie, who is serving with AmeriCorps|Vista at a school near the town, and to participate in Keene’s Annual Pumpkin Fest. I was looking forward to seeing the intricately carved pumpkins that had been widely featured in local and national publications, and to trying new taste sensations like pumpkin-flavored ice cream. I was excited about seeing a festival heralded as unique, beautiful, and of high quality.

Sadly, my expectations were far from met.

What began as a way to bring the community together with a focus on intricately carved pumpkins had devolved into a narrow emphasis on winning a prize for the largest number of pumpkins exhibited compared to other towns. In place of the glowing, beautifully patterned pumpkins I had hoped to see were 24,476 hastily and sloppily carved ones — 24,476 very, very sad pumpkins whose expressions told the story: “best” (quality) had been sacrificed for “most” (quantity).

And the final blow? After rushing to carve all those pumpkins, the people of Keene didn’t even win the contest. All they got was a whole lot of sorry pumpkins that didn’t reflect the spirit or the talent of the community.

All of which got me to wondering. Why do we feel compelled to turn everything — including, sadly and more seriously, healthcare services — into a competition, often losing sight of our true purpose along the way?

A recent analysis by Dr. Ashwini Sehgal, an associate professor of medicine, bioethics, and epidemiology & biostatistics at Case Western Reserve University, revealed just how much a hospital’s (not always accurate) reputation, and not the true quality of its care, can affect its spot in U.S. News & World Report’s “Best Hospitals” rankings. Dr. Sehgal’s own comment on his findings perhaps best sums up the imbalance: “I was flabbergasted that there was virtually no relationship between reputation and objective measures of quality” (quoted in the L.A. Times).

Sehgal’s findings are supported by additional evidence, such as the fact that the hospital ranked #1 by U.S. News this year was listed in Consumer Reports as 35th out of 62 hospitals in its own state alone based on its performance on established safety measures.

And yes, I know that many of you out there are saying “I could have told you that without any studies.” I agree.

All the same, I have a new, albeit extremely cautious, hopeful outlook on those “best” listings. Here’s why: on September 27th, U.S. News & World Report held its first national summit on hospital ranking systems, with more than 124 representatives from hospitals across the country attending. The summit’s focus was on ways to improve the current methodology for ranking institutions, making these evaluations truly reflective of the care the hospitals deliver.

Participants discussed such enhancements to the rankings as including care outcomes based on risk-adjusted data; patient experience data; and the amount of hospitals’ investment in information technology. Of perhaps greatest importance was the focus on ways to make the information in the rankings empower real informed decision-making by consumers.

Perhaps there is therefore some cause for hope that published rankings such as those in U.S. News will improve. A summit such as this one signals a first step in a long journey to getting past the hoopla of “best” or “most” and presenting quantifiable data that correctly reports hospitals’ real quality of care. If that happens, there is also hope that hospitals will be compelled to use this data to drive real improvement, and stay focused on their mission of delivering high-quality, cost-effective, appropriate care.

When people and organizations chase prizes or titles, they often lose sight of their core missions and goals — why they exist, what they want to do, what represents real success. But when they remain true to their purpose and their vision, they can achieve good, even great, and virtuous things.

I’d be all for awarding prizes for achievements like those — wouldn’t you? Prizes for excellence, worthy of being given and received, recognizing the accomplishment of something honorable, needed, worthwhile.

P.S. I did have pumpkin ice cream at the Keene festival. Once was enough, thanks. Make mine vanilla.

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