100 Top Hospitals Study: The Best Keep Getting Better

IBM Watson Health™ just published its 2018 100 Top Hospitals® annual study identifying hospitals whose leaders have guided their organizations to the highest level of balanced performance. The study, which was formerly known as the Truven Health Analytics® 100 Top Hospitals, has been measuring and studying the impact of leadership on hospital performance for 25 years. The study builds a balanced scorecard for 2,785 hospitals across the US, based solely on public data.

Those that score the highest in each of five classes are recognized as 100 Top national benchmark hospitals. Hospitals that have achieved national benchmark status are providing value to their communities through superior inpatient and 30-day care, financial stability as a major employer, shorter ED visits, high patient perception of care and lower total medical expense.

Hospitals use these benchmarks to help guide their own performance improvement initiatives, giving them real-world insight into the performance of their peers and a standardized scorecard to chart their progress over time. But the study also gives the broader healthcare industry a tremendous insight into the larger trends that are unfolding throughout American hospitals.

Nationwide Trend of Hospital Performance Improvement

Yes, the top hospitals in the study are outperforming their non-winning peers when it comes to quality measures like readmissions, patient satisfaction and hospital-acquired infections.

But even non-winning hospitals are trending in the right direction. In fact, 35.2% of all hospitals in this year’s study achieved significant improvement in their 30-day readmission rate over five years from 2011-2016 (the time period of this study). Length of stay was improved in 14.8% of all hospitals in the study in that time period. And patient satisfaction also showed a five-year improvement trend. As measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction rating scale, 12.2% of all hospitals in the study achieved measurable improvement over five years.

100 Top Hospitals Raise the Bar

That’s a pretty impressive improvement record being set by nearly 3,000 hospitals, but the subset that is the 100 Top Hospitals are doing even better. The Watson Health 100 Top Hospitals outperformed their peer group hospitals on every single clinical and operational performance benchmark evaluated in the 2018 study.

Following were the areas where 100 Top Hospitals show markedly better performance:

  • Better Survival Rates: Overall, 100 Top Hospitals winners achieved survival rates that were 26 percentage points better than those of peer hospitals.
  • Fewer Complications and Infections: Patients at winning hospitals experienced 13.4 percent fewer complications and 18.7 percent fewer healthcare-associated infections than peer group hospitals.
  • Shorter Length of Stay: Winning hospitals had a median severity-adjusted length of stay that was nearly one half-day shorter (0.4) than peers.
  • Shorter Emergency Department Wait Times: Overall, winning hospitals delivered median emergency department wait times that were 17 minutes shorter than those of peer group hospitals.
  • Lower Inpatient Expenses: Average inpatient costs per discharge were 7 percent lower (a difference of $460 per discharge) at 100 Top Hospitals versus peer group hospitals.
  • Higher Profit Overall Margins: Winning hospitals maintained a median operating profit margin that was 10.6 percentage points higher than peer group hospitals.
  • Higher Patient Satisfaction: Overall hospital experience, as measured by HCAHPS, was rated 3.4 percent higher for winning hospitals than peer group hospitals.

The Next 25 Years

After 25 years of the 100 Top Hospitals program, here’s what I see as I look ahead.

The next 25 years will be demanding, particularly now as the industry is transforming to a more patient-centered delivery system, with strong hand-offs, direct patient monitoring and cognitive learning technology to improve care. The delivery system will look nothing like it does today. Change will continue to be the only constant. Expectations for reliability will continue to rise i.e. the right care, at the right time, all the time.

As such, top-performing leaders must innovate and execute permanent organizational change by transforming the health system into a true learning organization. Artificial intelligence will underpin adjustments for personalized treatment in real time, in response to changes in condition for both inpatients and outpatients.

In times of great innovation and transformation to higher quality, lower costs and more patient-centered care, leaders must embrace and embed new technology, and more effective practices, into their organizations. This requires new data for the development of new learning organization measurement and monitoring to realize full value.

To support leaders in these critical endeavors, the 100 Top program will in the near future be adding new public metrics reflecting performance across the continuum of care, the ability to raise the bar of performance consistently over the long term, as well as the effect of conversion to learning organizations over time.

In the meantime…

As it stands today, the performance improvements measured in the 100 Top Hospitals study translate directly into more lives saved. Extrapolating the results of this year’s study, if all Medicare inpatients received the same efficient, quality care as those treated in the winning facilities:

  • More than 102,000 additional lives could be saved;
  • More than 43,000 additional patients could be complication-free;
  • More than $4.4 billion in inpatient costs could be saved; and
  • Approximately 200,000 fewer discharged patients would be readmitted within 30 days.

The full Watson Health 100 Top Hospitals study is available on our website.

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