Montgomery County’s hospitals received mixed grades in the latest review by the hospital safety advocate The Leapfrog Group.
The nonprofit’s Safety Grade survey scores hospitals based on 28 measures of patient safety, from preventing errors to staff performance and clinical efficiency. Leapfrog uses national performance measures from the Centers for Medicare and Medicaid Services, combined with its own hospital survey, to craft the grade.
The grades ranged from an A for Suburban Hospital in Bethesda to a D for Holy Cross, which has hospitals in Silver Spring and Germantown.
The grades are released every year in the summer and fall, typically in May and October, Leapfrog Director of Operations Erica Mobley said. The group scores more than 2,600 general acute-care hospitals across the nation that voluntarily participate in the free survey.
Leapfrog has advocated for increased public access to quality and safety data for more than a decade, attempting to provide greater hospital transparency for the benefit of patients.
“Safety can’t be something that people say, ‘OK this is going to be our focus for this quarter, then we’re going to check the box and move on to the next thing,’” Mobley said. “It really has to be something that’s so ingrained in the culture of a hospital.”
The measures used to score the hospitals are divided into two “domains,” Mobley said. Process and structure comprises policies and procedures in place to prevent errors, while outcomes accounts for the rate in which errors have actually happened. Results are put through scoring system to come up with a single numerical score, which is then translated to letter grade.
“The strongest indication of a hospital that is really a safe place for care, reflected in getting A grades repeatedly, is a hospital where safety is a top priority every single day,” Mobley said.
Suburban Hospital – A
The Bethesda hospital excelled in virtually every area, leading Maryland hospitals in staff cooperation to prevent errors, use of computer systems and reducing risks to patients. Suburban was one of 10 state hospitals to earn an A grade.
“It’s all about diligence and focus, that comes from our leadership,” Suburban Vice President of Medical Affairs Dr. Eric Dobkin said. “Our leadership team is focused on patient safety and the quality of care that we provide.”
Suburban has taken a preemptive approach to preventing errors, analyzing deficiencies at similar hospitals and taking measures to avoid those issues, Dobkin said. The hospital has also looked at areas where it hasn’t made mistakes, but may not be excelling, and worked to improve there.
Suburban was recently honored by the American Nurses Credentialing Center’s Magnet Recognition Program, the highest national mark for professional nurses, according to the hospital.
“Our entire workforce and our medical staff are entirely engaged in our endeavors,” Dobkin said.
Adventist HealthCare – B
Adventist has two major hospitals in the county, Shady Grove Medical Center in Rockville and Washington Adventist Hospital in Takoma Park, both scoring B’s. Shady Grove graded highly in staff performance measures, and Washington Adventist had above-average marks in surgery-related criteria.
“We always focus on quality and safety for our patients at Adventist Healthcare and its important to us to make sure we are always providing the best possible care for our patients,” Adventist HealthCare Senior Vice President for Quality Susan Glover said.
Washington Adventist struggled with safety issues such as preventing bed sores and some infections, while Shady Grove lost points in reducing patient risk and responsiveness, according to Leapfrog.
Similar to Suburban, Adventist HealthCare also looks outside of its organization for guidance on best practices, Glover said. The organization examines evidence-based policies and procedure throughout the industry and implements them as needed.
Glover added that one challenge with ratings groups are slight adjustments across criteria, which leads to inconsistencies.
“It’s very complicated,” Glover said. “The same measure may be measured a little differently by different agencies, and it may be related to a different time period. That makes the output of the data a little bit complicated at times.”
Medstar Montgomery Medical Center – B
The Olney facility scored well in most areas, earning the highest possible point total in effective leadership and quantity of qualified nurses. Medstar was docked slightly for communication and responsiveness, though their grades were right around state average in those measures.
“We at MedStar Health applaud efforts to create meaningful ways to quantify healthcare quality and safety,” the hospital said in a statement. “Delivering safe, quality care is at the forefront of everything we do.”
Medstar added that varying methodologies across ratings organizations can lead to confusion, and the hospital encourages patients to review a variety of resources before making healthcare decisions.
Holy Cross – D
Holy Cross also has two facilities in the county, with hospitals in Germantown and Silver Spring, both scoring ‘D’s. The hospitals each struggled with preventing errors and staff performance. Holy Cross also declined to report data in several areas.
Holy Cross Health Chief Quality Officer Dr. Yancy Phillips said the low grades for both Holy Cross hospitals were due more to a lack of participation than anything, evidenced by the choice to not provide information in some areas.
“We have made the judgment over the last few years that the juice was not worth the squeeze,” Phillips said, referring to the Leapfrog survey. “That it would not improve our care, but we would have a cost of reporting and compliance.”
Phillips noted that while participation is free, the cost of compliance is not. He added that Holy Cross has scored well with other organizations, including top 5% in the nation through Healthgrades and highest-rated hospital in the Washington region through the U.S. News & World Report.
Hospitals that decline to report are not docked for the lack of data, Leapfrog either obtains it from secondary sources or removes the measure from the overall analysis, Mobley said. This could lead to a poor performance if the hospital struggled in the metrics where data was available and is unable to balance out those failures with measures where it may have excelled, but didn’t provide data.
Holy Cross’ staff performance score was hurt by a lack of necessary quantity of qualified nurses, though data was only available for four of six metrics. Phillips said the hospitals actually have a robust intensive care staff, including at least two intensive care providers working at all times, along with a board-certified intensivist in-house at the Germantown location.
In the interest of maintaining public confidence, Holy Cross will participate in the Leapfrog survey moving forward and expects to have a better grade in the fall update, Phillips said.
“We’re not happy with [the grade], we don’t think it’s reflective and we’ve made the decision that it is worth the effort from a public perception standpoint to do reporting, and that’s what we’re doing moving forward,” Phillips said.
Charlie Wright can be reached at firstname.lastname@example.org