More than half of Hawaii hospitals were rated average or worse in a new patient-safety survey that already is under attack by the industry.
The report — scheduled to be released today by the national nonprofit Leapfrog Group — comes at a time when Hawaii hospitals are focusing on ways to improve patient safety as part of a nationwide effort aimed at reducing avoidable medical mistakes that lead to harm and even death.
Leapfrog relied on publicly available data for 26 measures, such as how often hospitals gave antibiotics to patients within an hour of surgery, to assign letter grades to more than 2,500 institutions nationally, including 12 in Hawaii.
Patient safety has been a hot topic since a landmark Institute of Medicine study more than a decade ago showed that as many as 98,000 Americans die each year from preventable medical errors. Experts say the situation hasn’t improved much since then.
Several local hospital representatives questioned the timeliness of the statistics analyzed by Leapfrog and whether the survey gave ample weight to a variety of factors, such as the unusual mix of patients seen by some hospitals.
"The data at this point (are) suspect," said Don Olden, chief executive of Wahiawa General Hospital, which gets 95 precent of its patients through emergency room admissions and received a below-average designation in the Leapfrog survey.
Olden noted that his small hospital — it has 53 acute-care beds — has so few procedures in some categories that one bad outcome can skew the percentages and present a misleading picture.
Six of 12 Hawaii institutions, including two that have closed, received C grades, according to Leapfrog, a Washington, D.C.-based organization that focuses on hospital safety and transparency.
Two other facilities, Kuakini Medical Center and Wahiawa General, received "score pending" designations, which meant their grades, if assigned, would’ve been less than C.
Kuakini spokeswoman Donda Spiker noted that some data Leapfrog used were one to two years old and didn’t necessarily reflect today’s conditions. She also questioned whether the survey took into consideration that Kuakini has the highest percentage of Medicare patients — 73 percent — of any hospital in the state.
Only two local institutions, Kaiser Foundation Hospital and Straub Clinic & Hospital, earned a top grade of A.
Dr. Ashish Jha, a Harvard School of Public Health associate professor and one of nine national experts who advised Leapfrog on survey methods, acknowledged that the grading system isn’t perfect and will get better over time as data collecting and reporting improve.
But the organization relied on the best information available and made necessary adjustments, such as giving older statistics less weight than more current data, according to Jha, who said he has no financial ties to Leapfrog.
And while many quality-of-care measures are generated from various public and private entities, this survey is significant because it pulls information from multiple sources to create an easy-to-understand grade in a process that is transparent, he said.
"This is a really important step forward," Jha said. "Consumers deserve this kind of information."
He cautioned, however, against reading too much into Hawaii’s small numbers to suggest a broader problem with hospital care.
"That said, certainly eight of the hospitals getting C or lower is concerning," Jha wrote in an email to the Star-Advertiser. "It just means, to me, that many of the institutions are not paying adequate attention to ensuring safe hospital care."
But even before the survey’s scheduled release today, the industry already was taking shots at it. In a message to its member institutions, the American Hospital Association, the national trade group, said many of the measures Leapfrog used were flawed and didn’t accurately portray the safety efforts made by hospitals.
Representatives from several C-rated Hawaii hospitals, including Pali Momi Medical Center, noted that their institutions exceeded state and national averages for various quality measures and received top marks in patient satisfaction surveys.
Hilo Medical Center spokeswoman Mary Stancill said her hospital, which also rated a C, received federal government rankings comparable to national rates for some key measures, including serious complications and death rates for patients who suffered heart attacks, heart failure or pneumonia.
Since those measures were taken, the hospital has made more improvements, so the next scores are expected to be even better, Stancill said.
Susan Young of the Healthcare Association of Hawaii, the local trade group, said Hawaii hospitals are working with the federal government to improve patient safety as part of a national initiative.
"They are all working on trying to do whatever is necessary to make sure patients are safe and (receive) the best evidence-based care," Young said.
Responding to its A rating, a Kaiser Permanente Hawaii executive referred to the organization’s use of rigorous measuring methods and its continuity of care to help ensure quality.
"You can’t have quality without metrics," said Susan Murray, vice president of quality, safety and service. "We consistently measure and evaluate our care providers, some of the best in the state, to encourage innovation, growth and improvement."
