Hospitals and ratings

Jun 14, 2019 Editorial

There are a small number of hospitals in this country. From time to time, there are alarming medical developments, usually fatalities, that trigger alarm and rage. Disappointment, pain, and resignation, too. There are not many options for either the strapped or nonpaying. And even when there is the luxury of paying, there could be the torture of failing to get what is due, what should be the norm of minimum standards.
It may not be a smooth fit, but a decent reference could be an article from US News & World Report by Andrew Camarow dated August 14, 2018, titled, “The Best hospitals in 2018-19 Honor Roll.”This is public recognition of the premier medical facilities in America, and offers a guide as what should serve as some form of gauge here, as to how things are, and guide on how to improve.
The word was that “too many hospitals fail” at the “relatively straightforward.” This is in the advanced US. Identified as straightforward were hip replacement, uncomplicated heart bypass surgery, and removal of a cancerous section of the colon. With the local exception of, maybe, heart bypass surgery, the other two are part of the “bread and butter” of hospitals with high standards expected.
And yet, there are surprises even among the top names in the top 20 honor roll. Surprises, not as to why they made the list, but their scores. Ratings were from a maximum 480 points in sixteen different specialty areas, including (now run-of-the mill Guyanese needs as) diabetes, gynecology, cancer, and gastroenterology.
Points accumulated based on death rates for challenging patients, patient safety, and reputational surveys of physicians, among other objective data compiled from 4,656 hospitals.
The top three US hospitals on the 2018-19 honor roll were the Mayo Clinic, Rochester, Minnesota (414), Cleveland Clinic (385), and Johns Hopkins Hospital, Baltimore (355). No surprises there. But what gives pause is that a stellar top three performer, such as Johns Hopkins scored only 355 out of 480 points. That is just under a revealing 75% score, and one not expected from prestigious Johns Hopkins.
It could be a function of the complicated cases undertaken and the (literally) grave challenges posed. Conditions from which lesser facilities shrink.
Rather surprisingly, in New York with the largest cluster of hospitals (and large contingent of Guyanese), the top-rated facility, New York-Presbyterian Hospital came in at only number 10 with a meager 242 points, or just over half of the total at stake.
Also in New York, at number 18 stood Mount Sinai Hospital with a scant 192 points, or 40% of the overall score.
Guyanese facilities caring for the sick can learn. First, even recognizable names on the list did not feature impressively. The overall scores of the high-volume New York Presbyterian (50.4%) and Mount Sinai (40%) were average to troubling; likely failures on any regular academic examination. Yet they are among the best of the best.
As the article confirmed, “It takes multiple years of progressive change to know if a hospital is truly improving…” It goes on to caution, that “For patients and their physicians, these rankings and ratings should be seen as just a starting point.”
Matters are complicated in the local environment, since many patients dabble with competing treatment regimes, through prescribed medicines and touted natural cures; and the complication of so-called “bush medicines” which cloud the treatment picture.
Further, highly skilled physicians are scarce, with green juniors, absent medicines and state-of-the-art technologies ever-present realities in domestic circles.
The state institution bears the brunt of reputational fallout and media storms, especially for what should be routine, as in maternal cases and care culture.
Nevertheless, local hospital managers should consider surveys, data gathering, and openness to appreciate where they stand and areas crying for curing action.