Leapfrog Patient-Safety Standards a Stretch for Most Hospitals

Campaign Raises Awareness of Patient Safety, but Lack of Financial Incentives Hinders Progress

News Releases
February 23, 2004

FURTHER INFORMATION, CONTACT:
Alwyn Cassil: (202) 264-3484

ASHINGTON, D.C.— While the Leapfrog Group’s ambitious campaign to improve patient safety in hospitals has sparked national awareness, few hospitals are close to meeting the group’s standards for computerized prescriptions, specially trained intensive care unit (ICU) physicians and volume thresholds for certain high-risk procedures, according to a study released today by the Center for Studying Health System Change (HSC).

"Leapfrog has clearly helped put patient safety on hospital radar screens, and many hospitals are trying to meet the spirit if not the letter of the Leapfrog standards by substituting less expensive alternatives," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.

"Many factors, including a lack of financial incentives, are hindering hospitals’ adoption of the Leapfrog patient-safety practices," Ginsburg said.

Formed in 2000 by the Business Roundtable, an association of Fortune 500 CEOs, to stimulate breakthrough improvements—or leaps—in patient safety, Leapfrog has championed three hospital patient-safety practices:

• Computerized Physician Order Entry (CPOE)—whether hospitals have an electronic prescribing system to prevent medication errors.
• ICU Physician Staffing—whether hospitals use physicians board-certified in the subspecialty of critical care medicine to provide care in adult medical and surgical ICUs.
• Evidence-Based Hospital Referral—whether hospitals meet volume thresholds for six high-risk procedures, with hospitals not meeting the thresholds referring patients to other hospitals.

The study’s findings are detailed in a new HSC Issue Brief—Leapfrog Patient-Safety Standards Are a Stretch for Most Hospitals. Based on site visits to 12 nationally representative communities in 2002-03, the study examines hospital patient-safety activities in Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. Additionally, the study used data from an HSC patient-safety survey fielded during the site visits and Leapfrog’s public survey data from November 2000 to April 2003. The study was co-authored by Kelly Devers, Ph.D., a former HSC health researcher and now an associate professor at Virginia Commonwealth University, and Gigi Liu, a former HSC research assistant and now a medical student at Stanford University.

Other key study findings include:

• The majority of hospital executives interviewed by HSC researchers stated that Leapfrog has raised national awareness of patient safety generally and the three safety practices in particular. Despite the positive impact of Leapfrog efforts at the national level, many hospitals reported that employers and health plans in their markets were not providing strong incentives, especially financial incentives, to meet the standards or participate in the Leapfrog survey.
• Hospitals’ efforts to meet the three Leapfrog standards often are seen by physicians as restricting their autonomy and reducing their productivity and income. As a result, hospitals must work to secure and maintain physician support. One hospital respondent captured the general sentiment well, noting that one of the "fastest ways to the CEO graveyard is to push physicians too hard and fast on patient safety and quality improvement."
• Leapfrog’s focus on selected communities—known as regional rollouts—has not yet prompted significantly greater implementation of the three hospital patient-safety practices in targeted communities. On average, hospitals in the five HSC site visit markets—Boston, Lansing, northern New Jersey, Orange County and Seattle— included in Leapfrog’s initial regional campaigns had not made significantly more progress toward meeting the standards than hospitals in the seven HSC site visit markets not included in the Leapfrog target areas.

The study concluded that efforts to improve patient safety are likely to be more successful if private and public purchasers collaborate to create strong incentives—particularly financial incentives—for hospitals to improve patient safety. The public sector also could complement Leapfrog efforts through collaboration on research, information technology, reporting and purchasing approaches.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely insights on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded exclusively by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.