New England’s Best Hospitals Rated By Patients

Monday, January 07, 2013

Joe Dilworth, GoLocalWorcester Contributor

Utilizing the results of more than 50,000 patient surveys of New England hospitals, GoLocal has created the first ranking of the region's hospitals based on patient ratings.

What are the best hospitals in New England--when it comes to what patients think?

Traditionally, hospitals are rated and ranked on a combination of sound technical care, adequate resources, and impressive statistics. But an increasing emphasis is being placed on perhaps one of the more important measures: the patient’s perspective. With that in mind, GoLocal has sifted through and analyzed the results from a government-survey of more than 50,000 patients in 176 hospitals in New England, and emerged with the first-ever patient-based ranking of the region’s top hospitals.

For more on the survey and GoLocalWorcester’s ranking methodology, go here.

The Hospitals

The 176 hospitals ranked from all over the region includes the largest research institutions to small community hospitals. In fact, the #1 hospital for 2012 is a 41-bed non-profit community hospital outside of Worcester, MA--Clinton Hospital.

What all the top finishers had in common is a commitment to patient-centered care, a characteristic that professionals now consider to be absolutely crucial.

“Studies have found that patient satisfaction measures may be important predictors of mortality, cost, and adverse drug events,” said Eva DuGoff, a PhD candidate at the Johns Hopkins Bloomberg School of Public Health, about the survey’s importance to hospital evaluation.

New England’s Top Hospital Rated By Patients: Clinton Hospital

Named the #1 hospital in New England by patient rating, Clinton Hospital in Clinton, MA, is a 41-bed community hospital.

Claiming the #1 spot is Central Massachusetts’ Clinton Hospital. The ranking is no surprise to hospital staff members, who say that every effort is made to listen to patient needs and doing whatever is necessary to meet those needs.

“Clinton Hospital is committed to patient-centered care, it’s the fabric of who we are and what we do here,” said Karen Plainte, Vice President of Quality and Resource Management at Clinton Hospital. “Even the smallest details contribute to a positive patient experience.”

Patients have certainly noticed Clinton’s attention to detail. Among respondents, 91% said their room was always clean, 68% said it was always quiet at night, and 90% reported that nurses always communicated well.

Plainte says patients are constantly remarking on the cleanliness of the hospital, suggesting it makes a major difference in patients’ comfort level and confidence in the care. She also says Clinton is continually trying to improve upon it’s “quietness,” an effort highlighted by the elimination of overhead paging and nurses offering patients ear plugs and white noise machines upon request.

But Clinton’s high-quality care doesn’t end when patients reach the discharge desk. The hospital has recently revised and streamlined its discharge paperwork so patients are not sifting through papers to find their instructions. The hospital has also created medication cards for the most commonly prescribed medications, helping patients to differentiate between their prescriptions and understand the side effects.

“Our staff (makes sure) to spend extra time with patients to go over their discharge instructions and to be certain that all of their questions have been answered,” said Plainte.

In all, Clinton Hospital is proud of its work and is determined to receive even more positive patient feedback.

“Scores aside, we believe that we are the best in what we do,” said Plainte. “Our staff is exceptional and patient-centered care is our culture of care.”

For New England’s Top 20 Hospitals, go here.

State With the Most Top Hospitals: Maine

The state of Maine is home to not only the world’s premier lobster and scenic wildlife, but also to some of the region’s best hospitals. Ten of GoLocal's top 20 slots are occupied by Maine hospitals, with Millinocket Regional Hospital the highest finisher at #4.

Maine placed 10 hospitals in GoLocal's Top 20 ranking, topped by #4 Millinocket Regional Hospital in Millinocket.

Among the reasons for the state’s strong showing is an emphasis on transparency.

“We have worked with the legislature on having hospitals publicly report how they do relative to their peers,” said Jeffrey Austin, Vice President of Government Affairs and Communications at the Maine Hospital Association. “Nothing motivates change more than a front page headline.”

Hospitals in the state are also committed to collaboration with one another and are committed to working together. Austin says facilities within the state are constantly sharing ideas on the best practices and suggestions for improvement. However, a competitive spirit between hospitals helps drive excellence.

“Obviously, there is competition among our members, but on quality they share best practices,” said Austin. “This is very important.”

A Study That Puts the Patient Experience at the Center

To best assess how patients view health care, GoLocal analyzed results from the Hospital Consumer Assessment of Healthcare Providers and Systems, also known as the HCAHPS Survey.

The standardized survey instrument asks a random sample of patients to give feedback about topics such as how well nurses and doctors communicated, how responsive hospital staff were to patient needs, how well the hospital controlled patients’ pain, and the cleanliness and quietness of the hospital environment. (For more on the survey and GoLocal’s methodology, go here.)

For experts studying the health care field, the HCAHPS Survey provides a unique insight into the patient experience.

“The HCAHPS Survey is the only survey that can tell you what patients from across the country think of their hospital experience,” said DuGoff of Johns Hopkins.

The survey, however, is very careful to ask detailed questions and avoid the inherent bias inextricably linked with general patient satisfaction surveys. Executive Director for the Stoeckle Center For Primary Care Innovation at Mass General in Boston, Susan Edgman-Levitan, who helped design the study, says HCAHPS asks objective questions and makes sure to stay away from typical satisfaction surveys, which are unpopular among clinicians.

“We focus very hard on things that patients can actually perceive and judge,” said Edgman-Levitan, told The New England Journal of Medicine. “We don’t ask anything about technical care because patients will be the first to tell you that’s not something they can judge.”

While it’s clearly a beneficial tool for assessing hospitals from afar, the HCAHPS Survey has also proven to be an effective tool for hospital administrators seeking to improve their levels of care.

“We use the HCAHPS scores to get a better idea of how patients perceive the care we are providing,” said Vice President of Patient Care Services at South County Hospital in Rhode Island Barbara Seagrave. “Each manager is responsible for monitoring their scores and developing action plans to address scores that drop.” (For how Central Mass hospitals ranked, go here.)

The Patient as Expert

Since becoming a widely used measure, a variety of critics questioning the HCAHPS Survey have emerged. They argue that patients aren’t credible critics because they haven’t attended medical school, assessments are based on factors not related to the process of quality, or that patients will downgrade doctors for not giving them what they want.

However, developers of the HCAHPS Survey insist the test does not ask patients to judge aspects of care they cannot understand, and every effort is made to keep questions uniformly objective. By sticking to these fundamental principles, the test allows health care professionals understand how effectively they are performing and communicating with patients.

“I think that what we’re seeing is that when you really educate people about what their options are and what’s going on, they’re not demanding a lot of really unreasonable things and I think this survey is picking up on that,” said Edgman-Levitan.

In addition, unbiased patient feedback can be highly effective in breaking through the bureaucratic tape and political climate within the health care field.

“Patients and families don’t understand all of our turf issues, they cut right through it,” said Edgman-Levitan. “When the patient says, ‘this would be helpful to me,’ it’s much easier for the different professions to respond to it rather than fight over who knows the patient best or who has best solution.”

The Importance Of Patient-Centered Care

In recent years, health care professionals have acknowledged the importance of patient-centered care and developing methods to evaluate the care.

“In the past ten years, there has been an increased interest among health care providers in adopting patient-centered models of care that extend from patient-centered primary care practice to patient-centered medical records,” said DuGoff.

And with good reason. Patient-centered care methods have proven to be highly effective for patients’ general health.

“Most of the well designed studies have found that there are important correlations between clinical outcomes, reduced readmission rates, reduced malpractice risk, and better patient outcomes in general,” said Edgman-Levitan.

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