Best Hospitals List Drives Reputations

U.S. News & World Report just released their 2011 list of “best hospitals.”
This list, hugely popular with consumers, is the source of much angst among the nation’s hospitals.  And for good reason; these rankings of best hospitals in 16 specialties are big drivers of reputation.

Johns-Hopkins was ranked number one for the 22^nd year.  If Hopkins were an athlete, you would have to retire its jersey.  Massachusetts General Hospital secured the second top spot, moving the Mayo Clinic to number three.

These hospitals are the elite of the elite, but to understand how truly select this “best hospitals” list is, you only have to look at the numbers.   There are 4,825 hospitals in the U.S. and only 140 hospitals made the 2011 list.  This is a status many aspire to but few are chosen.  U.S News also issues a regional list of 740 “best hospitals”, but this does not garner nearly the attention or prestige of the national list.

So how do hospitals get on this list, and what can they do to improve their standings or make the list for the first time?  It turns out that reputation plays a very big role, and that is one of the variables that hospitals can shape.

Every hospital would like to be singled out as one of the nation’s best, but the criteria severely winnow the field.  To even initially qualify, a hospital must meet certain standards:  an academic medical center or   medical research affiliation; four or more types of advanced medical technology; and a specified volume of procedures conducted in a medical specialty.

Once a hospital makes this cut, it is measured by quantitative and qualitative criteria that include mortality data, nurse to patient ratio, and reputation.

The data criteria are, of course, fixed and “objective”.  Yet reputation, a highly subjective criterion, constitutes 32.5% of the evaluation.  It is based on interviews with physicians in their respective clinical specialties.   Two hundred physicians in cardiac care, for example, are asked to name five hospitals that they believe are the best in this arena.

When you balance this out with the hard data from the other categories, it seems like a reasonable way to select the best hospitals in a given specialty.  It is interesting to note that of the 16 specialties, four – psychiatry, rehabilitation, ophthalmology, and rheumatology – are based on reputation only.  The reason for this is that mortality and other clinical indices are not relevant for these specialties.

Hospitals that have rankings in six or more of the 16 specialties made the “honor roll”, this year comprising 14 of the nation’s most elite hospitals. 

While no one would dispute the worthiness of the hospitals on the honor roll, or any of the lists, it is not an entirely level playing field in the reputation arena.

Great reputations are developed over time, and once achieved are very hard to dislodge.   Centers such as Johns Hopkins, the Mayo Clinic, and the Cleveland Clinic are so well established in many clinical areas that it is almost a given that they will be cited by physicians in a specialty area.  With only five choices, physicians choosing the best hospital for heart are likely to name a few of these “mega-stars” automatically, restricting choices in well-deserving but not as well known facilities.

Established reputation is the best guarantee of scoring well in the lists’ reputation category.  Such is the power of reputation that it has a halo effect.  Several years ago, consumers were asked to name the best school of dentistry in the Mid-Atlantic region; the overwhelming response was Johns-Hopkins.  Only one problem, Hopkins did not have a school of dentistry.   This “halo effect” may be at work in physician choices for certain specialties

For hospitals, the issue of reputation is chicken and egg.  You need one to get one.

So, how can providers influence the reputation portion of these rankings?

It starts with a commitment to telling the hospital story.  Reputations are built over the years by word of mouth from patients and a steady stream of news in the media.  Outstanding patient care and clinical research will not build reputation alone unless that story is told through a variety of news outlets.   Most all of the premier hospitals have strong media relations programs that tout clinical trials, technology advances, and other news of their institutions.  They are increasingly using online strategies and social media to target consumers and physicians.

The internet has hugely expanded outlets for healthcare news and medical information.  In a recent survey, physicians report that 85% of their patients brought internet health information to appointments.  Physicians are increasingly getting their information less from medical journals and more online, spending an average of eight hours a week on physician communities like Sermo and WebMD’s Medscape Physician Connect. 

While online news sites influence physicians just as they do consumers, so, too, does the mainstream media.  Clearly, physicians rely on medical journals, yet they are also consumers of news.  They read the New York Times, the Wall Street Journal, and other national media.  One recent study revealed, astoundingly, that physicians get more healthcare news from consumer outlets than they do medical journals.

The takeaway here is that developing a national news profile is one of the most powerful ways a hospital can build its reputation.   Most of the hospitals in the top tier of these lists understand this, and they are vigilant in maintaining their reputation through aggressive news outreach.

For hospitals aspiring to the U.S. News list, or ones that want to improve their rankings, the advice is simple.  Do good work and make sure that work is trumpeted in national media outlets.