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Duration: 6:06

This podcast is an episode of Patient Safety Updates. You can find other episodes and subscribe using the links to the left.


  • Stephen Flaherty
  • Erica Mobley
  • Nina Rauscher


In early 2015, an honorary distinction began to appear on web sites and publications for many hospitals across the country, 94 to be exact. They are the nation’s Top Hospitals, according to quality watchdog The Leapfrog Group. Leapfrog is well-known as an advocate for health insurance purchasers to promote better health care outcomes, efficiency, and safer care. The number of hospitals choosing to participate in its annual survey has been growing steadily since it started in 2006. Dana-Farber Cancer Institute in Boston was among the group of most recent honorees for 2014.

“I think having a Leapfrog designation like this… affirms the work that many of the people who see patients do every day. And it’s wonderful to have outside organizations recognize us for that.”

Stephen Flaherty is the Program Manager for Quality Measures at the Farber. He says scores on infection control standards have been improving steadily at his institution:

“There are some really detailed interesting things like changing processes and using ethanol impregnated caths so that when you actually put a needle into someone’s arm, you make sure that it’s going through ethanol to clarify it and make sure that there is not an opportunity to cause an issue. But on a very high level for infection control, we have for many years—and we’ve espoused this I think at many, many meetings—we’ve made infection control a top priority. At almost every board level meeting, at infection control committee meetings, at our nursing staff meetings, in the huddles of all of the nursing staff and all of the care providers that we have, we talk about infection control all the time.”

This is the first Leapfrog Top Hospital designation for DFCI. Although Leapfrog has separate categories for children’s hospitals and rural, it includes specialty hospitals in the same category as general acute care hospitals. Questions on the survey cover a variety of quality and safety measurements, such as use of computerized order entry, availability of an ICU physician, early elective C-section rates, and 30-day readmission rates, as well as safety culture measurement. Bar code medication administration is a new measure this year. In order to avoid overburdening hospitals, Leapfrog works to align its surveys with existing requirements from major agencies. If consumers can get the same information elsewhere, Leapfrog will remove a measurement from its survey. Erica Mobley is Director of Communications and Development for Leapfrog.

“The Leapfrog Group was founded by employers and persons of health care who recognize that they were spending millions of dollars to provide health care benefits to their employees. But they didn’t really have a sense if the care their employees were getting was any good, particularly as it pertains to hospital care. So they created the Leapfrog Hospital Survey to be able to get this information from hospitals. Leapfrog remains a purchaser coalition, and our board is governed by a majority of health care purchasers.”

Mobley says participation in the Leapfrog survey rises every year, even as the measures have gotten tougher. Massachusetts doubled its representation on the Top Hospital list with 10. Specialty hospitals like Dana-Farber or other Bay State honoree, Massachusetts Eye and Ear Infirmary, have a slightly different review.

“One difference that we might see is that a specialty hospital may not perform all of the procedures that a general acute care hospital would, and if that’s the case, they’re simply not evaluated on the procedures that they do not perform. But we’re still looking at the same areas of overall care such as CPOE, such as the safe practices and if a hospital has a Never Events policy in place. Those measures are applicable regardless of the type of facility. So it is nice when we’re able to recognize specialty hospitals but they are still evaluated against the same criteria as general acute care hospitals."

Boston Children’s Hospital is also on the list, as it has been for the previous five years. Nina Rauscher is the Executive Director for the Program of Patient Safety and Quality. Rauscher points out that participation in the Leapfrog survey is required by some purchasers, and her institution has worked with Leapfrog over the years to recognize unique needs of pediatric populations, especially in the area of electronic medical records.

“The thing that’s very interesting this year which, I’m pleased to hear, is that they’re now going to add an inter-rater reliability component. So, you’re sitting there and how do you score yourself? And now I understand there’s going to be an audit process.”

Steve Flaherty at Dana-Farber says that what gets measured for patient safety and quality is always up for discussion, as professionals recently did at the National Quality Forum that Flaherty attended in Washington, D.C. this spring. He says that the Leapfrog Top Hospital survey and other rankings can always get better, but they help a health care organization know how it’s doing.

“It does help for us to know who our peers are and to see what’s achievable. If there are organizations that are performing better than us, whether they be oncology centers or other types of centers that are specialty centers or acute care hospitals, it’s always good to know what’s possible and who’s very, very good in the field so then we can reach out to them and try to learn more and to do more with it. Leapfrog and many other groups that rank hospitals allow us to see what others are doing and to really start to focus on really top performers.”

Also this spring, Leapfrog for the first time posted past hospital scores and trends. That, and other information, is available online at: hospitalsafetyscore.org

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