Hospitals are routinely asked to participate in surveys measuring the quality of care provided. As hospitals consider whether to invest the time and manpower into completing these surveys, they need to be assured the survey is using evidence-based metrics that promote quality and safety improvement. For that reason, Iowa hospitals have historically not participated in the Leapfrog Group Survey.

The history of Leapfrog

In 2000, a number of large employers and public purchasers founded the Leapfrog Group in an attempt to persuade hospitals to adopt practices thought to improve the quality and safety of medical care. The Leapfrog Group initially recommended three hospital patient safety practices, or “leaps”:

• Computerized physician order entry.
• Staffing of intensive care units by trained intensivist physicians.
• Evidence-based referrals for high-mortality surgeries.

Unfortunately, these leaps primarily targeted urban hospitals. In Iowa, this would equate to 18 percent of the 117 community hospitals. To quote the Leapfrog Group, “Computer physician order entry and ICU physician staffing are still considered a stretch for rural hospitals because of the staffing and resource constraints involved in fully complying with them.”  This may lead one to question why Leapfrog  set forth benchmarks that hospitals would be unable to achieve.

The Leapfrog Safe Practices Survey and response from JAMA

In 2004, Leapfrog adopted a fourth initiative, the Safe Practices Survey. Leapfrog said this would allow all hospitals to report efforts toward implementing the National Quality Forum’s Safe Practices for Better Healthcare.

Fast forward five years to a study just published in the April 1 edition of the Journal of the American Medical Association. That study showed hospitals that ranked highly on the Leapfrog Group’s Safe Practices Survey had about the same inpatient mortality rates as facilities with lower rankings.

In a written response, the Leapfrog Group said that the study addresses only one of several elements of the hospital survey, adding that the data used in the comparison “limits the conclusions that can be generalized from the study.”

The Leapfrog Group adds that although the process and structure measures in the Safe Practices Survey are “perfectly sensible…clearly we cannot assume that structural and process improvements automatically lead to the outcomes we desire.”  This explanation from Leapfrog echoes Albert Einstein, who said, “Not everything that can be counted counts, and not everything that counts can be counted.”

Iowa hospitals continue to receive high marks

In study after study, Iowa hospitals continue to rank at the top of the leader board for quality patient care. Part of this success can be attributed to the ongoing work of the Iowa Healthcare Collaborative, a provider-led nonprofit organization designed to promote rapid cycle clinical performance improvement. IHC’s initiatives facilitate engagement, the sharing of data and the rapid deployment of best practices. IHC highlights success stories and reports on clinical performance information in its 2008 Iowa Report. The IHC Board has also affirmed its position that Iowa hospitals not report to the Leapfrog Group.

Questions?

Do you have questions about the Leapfrog Group survey or IHA’s position on this issue? Please leave a comment and a member of IHA’s staff would be happy to respond.