Midwest tops nation in patient safety performance: coastal states—including NY, CA—lag behind

HealthCare Benchmarks and Quality Improvement, June, 2005

Patient safety at hospitals varies dramatically across the nation, but the highest performance on patient safety is centered in the Midwestern states, not the most populous states on the coasts, according to new findings by the Ann Arbor, MI-based Solucient Center for Healthcare Improvement.

Eleven out of 12 states in the Midwestern region were ranked highest in terms of patient safety, including Minnesota, Wisconsin, Indiana, and Ohio. New York, New Jersey, Nevada, and California were ranked among the poorest performing states in patient safety. The findings are part of the Solucient 100 Top Hospitals: National Benchmarks for Success, 12th Edition study, which included patient safety as a measurement for the first time.

"We created maps that very clearly show which parts performed well on the study overall and on patient safety," explains Jean Chenoweth, senior vice president of performance improvement and 100 top programs for the Center for Healthcare Improvement, which is responsible for Solucient's 100 Top Hospitals program.

"We treat all states like [we would] a hospital and then re-run the study, where we are able to put all states in quintiles on the basis of the 100 top measures. We compared performance in 2004 vs. 2003 and found a big shift away from the South and up into the Midwest," she explains.

In fact, according to Chenoweth, when people look at the color-coded 2004 map in quintiles, they can see most of the light green and dark green--indicating the highest patient safety scores--are "just about all in the Midwest."

In addition, states such as Washington, Oregon, Colorado, Arizona, and New Mexico continue to perform well, she points out. "What was different was the shift away from Florida, Tennessee, North Carolina, Virginia, and Missouri," Chenoweth adds.

This is a reversal of past trends, she continues. "The South had been leading for a long time; now, it looks like desert colors," Chenoweth observes.

Looking for reasons

Chenoweth proposes a number of possible reasons for the shift.

"If you look at California and New York, you'll see they are deep red," she points out. "What you seem to have with all the little red spots are heavily regulated states performing at the bottom in terms of patient safety. California, for example, has been more and more regulated over the past decade, and I think there is probably a relationship there in terms of what those hospital leaders are focused on," Chenoweth explains.

"In California, they are probably focused on nursing [staffing ratios], restructuring buildings [to meet earthquake standards]--other things that have to take priority," she notes. "In New York, they may be focused on their financial condition."

On the other hand, Chenoweth continues, "There are a number of possible reasons why the Midwestern states are doing so much better than California and New York, one of which may be the focus of health care leaders in the Midwest on both performance improvement and public reporting of performance.

"For example, in Wisconsin, a large group of hospitals initiated the development and reporting of measures of hospital quality directly to the public," she adds.

The Wisconsin effort was voluntary, Chenoweth points out. "Minnesota also has a big effort on to report medical errors. Iowa has been participating in a number of studies on patient safety and leadership and has turned out in public data to suddenly be performing very well. Connecticut initiated public reporting and has done pretty well."

Other states that have strong initiatives and performed well include Pennsylvania (dark green) and Michigan. (For more information on Michigan's initiatives, see "Keystone project yields results in six months," Healthcare Benchmarks and Quality Improvement, Patient Safety Alert supplement, April 2005. For more on Pennsylvania's initiatives, see "Unique patient safety authority enables sharing of lessons learned," HBQI, January 2005, p. 1.)

"At least in a number of these states, there have clearly been initiatives focused on public reporting and/or patient safety," she observes.

"If those initiatives are major priorities for the CEOs in the industry, then change will occur." The impetus comes from various sources, adds Chenoweth.

"In Connecticut, it was the state; in Wisconsin, it was the hospitals themselves--a group of CEOs. In Michigan, it was the hospital association," she explains.

The bottom line is quality managers don't have to wait for their states to take the initiative in starting such programs, Chenoweth notes. "And the proof of the pudding is clear."

Establishing a baseline

By measuring patient safety for the first time, Solucient is establishing a baseline from which to compare hospitals in the future, Chenoweth explains. "What we've done is add patient safety as a measure in our Top 100." (See Putting the data together.) "We show performance against national benchmarks and national medians for a hospital's peer group. We also trend data backward across five years," she adds. (These data were released April 25.)