Harvard Health Care Blog Debut: How To Use Hospital Rankings


Click on your bookmarks tab, please, everyone. Announcing a new blog that looks very worth following: An Ounce of Evidence, featuring Dr. Ashish Jha, The C. Boyden Gray Associate Professor of Health Policy and Management at the Harvard School of Public Health.

In his first package, Dr. Jha not only analyzes the recent harvest of hospital rankings from U.S. News and World Report, Consumer Reports and The Leapfrog Group. He also offers guest posts from some of the the rankers themselves, discussing what they do and why.

Dr. Ashish Jha (HSPH)

As health policy goes, the blog is shockingly readable (yes, that’s a left-handed compliment if ever there was one) and uses car-shopping as a helpful analogy. For example:

If you’re lucky enough to find a hospital that gets rated highly by all three organizations, I’d take that in a heartbeat. It’s like finding a car that drives well, looks stylish, is reliable, and safe! No brainer. Unfortunately, those hospitals are rare. In Boston, Massachusetts General Hospital was ranked the #1 hospital in the country by U.S. News. It got an “A” from Leapfrog. It was near the bottom of Massachusetts hospitals in the CR rating, receiving a score of just 45 out of 100.

It can be easy to decide if the safety, or the style, or the performance of a car is most important to you. Unfortunately, choosing what’s most important in health care can make us ask difficult and seemingly unreasonable questions. Is my primary goal to survive my hospitalization, avoid infections and medication errors, or have a reasonably good experience? Every individual has to decide what matters most. If a low mortality rate is most important, U.S. News is your best bet. If you care most about patient safety, then Leapfrog is the way to go. Consumer Reports emphasizes infections, unnecessary radiation and patient experience. If those matter most, CR is your best bet.

My personal list ranks mortality as most important (by far), followed by safety, with patient experience an important but distant third. Others will make different choices.

So why, I asked, is Dr. Jha, a prominent researcher and practicing physician, adding a blog to his very full plate? He explained:

“We do a lot of research, and with a lot of data, we don’t necessarily want to publish it in a journal. Sometimes the timeline is such that you can’t get it out fast enough; sometimes maybe there’s an interesting fact but it’s not enough for a paper. I’ve been looking for a venue to try to get more data-driven ideas out. And part of it is really driven by my own thinking about health care policy, which is that I personally don’t feel like we need a lot more opinions about how to make the health care system work better; we need a lot more evidence about how to make the health care system work better.”

Hear, hear, say I. And what will An Ounce of Prevention most focus on?

It aims to focus on big health policy issues as they break, Dr. Jha said, or ideas and data generated by his group. And he’d like to be able to run quick analyses and share them publicly. For example, The New York Times has been writing recently about the profitable hospital chain HCA; the blog could run the quality numbers on HCA and post them, bringing that evidence to the discussion.

A rather ticklish question of mine: Academics tend to get no “points” with their universities for media appearances and blogging. But I assume you have tenure and don’t need points??

No, Dr. Jha said, he doesn’t yet have tenure and one of his colleagues told him that blogging would bring all risk and no benefit. But, he said, life isn’t only about points. “I think evidence and data can really move the world,” he said, “can really shape policies to be more effective. And I’m looking for all the venues where I might be able to do that. I don’t need academic credit for everything I do. Today I’m at the hospital seeing patients. As far a the university is concerned, I get no “credit” for that either. But why do I see patients? Because it’s very meaningful to me.”

One issue that concerns him, he said, is that he’s used to having weeks or months to think about and vet what he publishes; as a blogger, he may post something, then consider it further and realize he has changed his mind. But that’s okay, he figures; he’ll just post anew. “There’s no doubt it’s new terrain,” he said, “and I’m going to make mistakes along the way.”

The Harvard School of Public Health’s John McDonough has been blogging for the Boston Globe, but Dr. Jha is the first faculty member going forward with his own blog based at the school of public health, and he says others will be watching to see whether it has valuable impact.

Personally, I’m hoping the message they get is “Come on in, the water’s fine.” More evidence-based posts and less pure bloviation in the blogosphere would surely be a very fine thing, no?

Correction: The excerpt above originally contained an error; the correct Consumer Reports score for Massachusetts General Hospital was 45 out of 100.

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