Understanding the data behind a Tallahassee hospital's low safety grade
As a patient, going to the hospital can be anxiety-inducing. There’s the potential need for a procedure, and worries about the outcome, the cost, and the safety of the hospital.
In an effort to give patients more transparency, organizations like Leaprog and the federal government with Medicare have developed hospital safety surveys. Judging hospitals is complicated, but Tallahassee Memorial Healthcare's rankings don’t impart much confidence.
For the past several years, Tallahassee Memorial Healthcare’s hospital safety grade from LeapFrog has been dismal.
The hospital’s current safety grade according to Leapfrog is a D. That’s up from an F in the spring of 2020, and down from a C in the Spring of 2021. TMH also didn’t score well on another commonly used hospital rating site-- Medicare’s star rating system. Right now the hospital has one star overall and two stars for patient experience.
But Janna Iezzi-Tumblin, TMH's Chief Improvement officer says those rankings don't give a complete picture.
"We’ve talked about in the past the fact that it’s older data. So obviously it’s not the most current information. So your first question is going to be if we’re not doing well in an area well, if that was 2-and-a-half years ago, how are we doing today? So there’s some drill down that we need to do to see what is relevant that the score is showing us and what might be not as relevant," Iezzi-Tumblin says.
Iezzi-Tumblin says it's also important to explore whether there's a reason for why the score is low.
“It could be we truly, maybe we have a practice that is outdated and we need to update it. But it could also be for other reasons. Documentation has been a big one that we have been focusing on recently," Iezzi-Tumblin says.
As an example Iezzi-Tumblin points to one area where the hospital has a below average score. It looks at death among surgical inpatients with serious complications.
That could include something like pneumonia. Iezzi-Tumblin says when doctors are examining a patient following surgery, they might make notes about a possible case they want to keep an eye on, but might not follow up later to note that pneumonia was ruled out.
"So sometimes it’s very simple things that will cause a measure to look like it’s in worse shape than it really is. So that’s not a care issue. There wasn’t anything that wasn’t safe about what happened with that patient. It was sometimes us saying ‘hey we’re working up the patient and we think there might be this issue with the patient’ and we never went back and said, ‘oh, actually we ruled it out and that’s not the case,'” Iezzi-Tumblin explains.
TMH says it’s working to improve areas of care and safety, but it’s also working to improve its systems for reporting the data that’s collected. Florida Hospital Association CEO Mary Mayhew says TMH isn’t the only hospital that’s struggled with data issues.
“It is an area that requires significant financial investment and depending upon what you have for resources, and especially related to whether you are a part of a much larger system, that can be a challenge even though hospitals large and small have been making significant investments in health information technology," Mayhew says.
Mayhew says another problem is that many of the hospital rating systems rely on data collected through administrative claims. Mayhew says that data wasn't designed for evaluating care.
“Claims data inherently has a lag. And what we all ultimately want to see is rapid cycle improvement—quarter over quarter and in order to do that, you really do need real time data to drive that kind of urgent rapid change," Mayhew says. "We’re getting better and better, but it is not where ultimately we want to be so that the grade you have is ultimately reflective of your performance.”
But Mayhew says that doesn’t mean hospital rating systems aren’t a good tool to help patients decide where to seek care. She says the state’s hospital system benefits from informed patients, but she recommends using the data as a springboard for questions.
“They can ask ‘what does this score mean?’ If you want to really understand, asking the hospital ‘why are you a B rather than an A? What have you over the years as a hospital been focused on related to improving the distribution of medications? How do you use data in your hospitals to inform patient care among your teams?’”
Mayhew says despite valid concerns about how hospital safety surveys collect and use data, many hospitals in the state receive high scores—making Tallahassee Memorial, an outlier.
“Florida ranks 10th in the country with the percentage of our hospitals that have A ratings. So that is a great piece of data that demonstrates the commitment that Florida hospitals have to continuous processes of quality improvement," Mayhew says.
Florida’s Agency for Healthcare Administration recently finished the rulemaking process requiring hospitals to participate in another survey that’s focused on helping hospital managers getting a better understanding of hospital culture.