Excerpts and Opinions on “What Makes a Hospital Great?”

March 17th, 2011 by Nick Jacobs Leave a reply »

Dr. Pauline W. Chen’s March 17th New York Times article answers the question, “What Makes a Hospital Great?” In this article, Dr. Chen finds:

Dr. Pauline W. Chen - surgeon & New York Times contributor - Nick Jacobs, FACHE

Pauline W. Chen, MD | Blog: paulinechen.typepad.com

“Hospitals have long vied for the greatest clinical reputation. Recent efforts to increase public accountability by publishing hospital results have added a statistical dimension to this battle of the health care titans. Information from most hospitals on mortality rates, readmissions and patient satisfaction is readily available on the Internet. A quick click of the green ‘compare’ button on the ‘Hospital Compare’ Web site operated by the Department of Health and Human Services gives any potential patient, or competitor, side-by-side lists of statistics from rival institutions that leaves little to the imagination. The upside of such transparency is that hospitals all over the country are eager to improve their patient outcomes. The downside is that no one really knows how.”

I’ve written often about the failed promise of technology alone, and this is reaffirmed in Dr. Chen’s findings:

“…hospitals have made huge investments in the latest and greatest in clinical care — efficient electronic medical records systems, ‘superstar’ physicians and world-class rehabilitation services. Nonetheless, large discrepancies persist between the highest and lowest-performing institutions, even with one of the starkest of the available statistics: patient deaths from heart attacks.”

As she asks why this is,  the answers have become relatively clear from a study that was released in the Annals of Internal Medicine this very week. This research indicated that it was not the expensive equipment, the evidence-based protocols, or the beautiful Ritz Carlton-like buildings. It was, instead, the culture of the organization.

Hosptials in both the top and bottom five  percent in heart attack mortality rates were queried by the study team. One hundred fifty interviews with administrators, doctors and other health care workers found that the key to good (or bad) care was “a cohesive organizational vision that focused on communication and support of all efforts to improve care.”

Elizabeth H. Bradley, Phd, Yale School of Public Health

Elizabeth H. Bradley, Phd, Yale Global Health Leadership Institute

“It’s how people communicate, the level of support and the organizational culture that trump any single intervention or any single strategy that hospitals frequently adopt,” said Elizabeth H. Bradley, Senior Author and Faculty Director of Yale University’s Global Health Leadership Institute.

So, it wasn’t the affiliation with an academic medical center, whether patients were wealthy or indigent, bed size, or rural vs. urban settings that mattered in hospital mortality rates. Rather, it was the way that patient care issues were challenged that made the difference. The physicians and leaders at top-performing hospitals aggressively go after errors. They acknowledge them, and do not criticize each other. Instead, they work together to identify the sources of problems, and to fix them.

One of the most telling findings in this study was that relationships inside the hospital are primary, and the physicians and staff must be committed to making things work. Dr. Bradley said. “It isn’t expensive and it isn’t rocket science, but it requires a real commitment from everyone.”

So, the next time that you select a hospital, look up its statistics, and I guarantee you that you will be surprised. When it comes to outcomes, to nurturing or even competent care, the biggest is not always the best.

Learn More:



  1. When you go in search of honey you must expect to be stung by bees.

  2. Great post, I want thank to author becaus i’ve read here a lot good knowledge. Keep it going! 🙂 . Best regards

  3. For such a good post, Im pretty dissapointed at the quality/quantity of comments.

  4. Allie Cooper says:

    Nicely… to become fully honest, I failed to be prepared to discover this sort of information by chance, as I did so, because I just discovered this web site even though I was actually conducting research online in the search engines, searching for some thing extremely close however, not very the same… On the other hand right this moment I am just over thrilled to always be below and I would really like to include that your standpoint can be remarcable despite the fact that the trifle questionable to my own taste… I would alternatively say it should be around debate… yet Now i’m afraid to make you an opponent, haya, ha, ‘… At any rate, in case you want to speak in greater detail regarding it, you need to reply to our opinion along with I will be sure to join to ensure that I will be informed and also come back for additional…

  5. Marni Bretz says:

    An impressive share, I just supplied this onto a colleague who was executing somewhat examination on this. And he in reality purchased me breakfast like a result of I found it for him.. smile. So enable me reword that: Thnx with the deal with! However yeah Thnkx for spending the time to discuss this, I really really feel strongly about it and love browsing a lot more on this matter. If doable, as you alter into encounter, would you thoughts updating your weblog with excess details? It is hugely useful for me. Major thumb up for this weblog submit!

  6. prayer says:

    I believe other word wide web site proprietors should take on this internet site as an model, really clean and good user pleasant fashion and style, likewise as the information. That you are an specialist in such a subject!

  7. Nokia huolto says:

    For me an ideal hospital has a good doctor and not late cause in some place the doctors are always late and the patient are always waiting.In Finland where i live and working in a Nokia service i can say the our hospital are doing a very good job cause they are doing their promise to help people and the fact that doctor are always on time?

  8. extremists en route for any thrust homespun the perspective or even claim that everyone else from the world is located sin against. thank on your to the point as well as related understanding.

  9. I am curious to find out what blog platform you’re using?
    I’m having some minor security issues with my latest website and I would like to find
    something more safeguarded. Do you have any recommendations?

    Look into my web blog :: http://tinyurl.com/n77d7zn

  10. Tia says:

    This design is wicked! You definitely know how to keep a reader entertained.
    Between your wit and your videos, I was almost moved to
    start my own blog (well, almost…HaHa!) Excellent job.
    I really enjoyed what you had to say, and more than that, how you presented it.
    Too cool!

    Here is my blog … website – Tia,

  11. This is not to say there was no science involved with ninja weapons.
    His students consisted of some of Hollywood’s most elite, including Kareem Abdul-Jabar, Steve Mc – Queen, James
    Coburn, Joe Lewis and Chuck Norris. A few years ago the Thornwood MMA head instructors sat down and
    developed the ultimate style of fighting and self-defence
    “” Thornwood MMA System, which integrates the three
    major areas of combats into one system.

  12. We stumbled over here different web address and thought I might check things out. I like what I see so i am just following you. Look forward to looking into your web page repeatedly.

  13. Hello, you used to write magnificent, but the last few posts have been kinda boring… I miss your tremendous writings. Past several posts are just a little out of track! come on!

  14. roxy says:

    You have brought up a very excellent details , appreciate it for the post.

  15. You have remarked very interesting points ! ps decent web site . “In music the passions enjoy themselves.” by Friedrich Wilhelm Nietzsche.

  16. gry online says:

    I like this post, enjoyed this one thanks for putting up. “To the dull mind all nature is leaden. To the illumined mind the whole world sparkles with light.” by Ralph Waldo Emerson.

  17. gra online says:

    You could certainly see your skills within the work you write. The arena hopes for even more passionate writers like you who are not afraid to mention how they believe. Always follow your heart. “Until you’ve lost your reputation, you never realize what a burden it was.” by Margaret Mitchell.

  18. I got what you intend, thanks for posting .Woh I am happy to find this website through google. “I would rather be a coward than brave because people hurt you when you are brave.” by E. M. Forster.

  19. You are my inspiration , I have few web logs and rarely run out from to post .I believe this internet site has some real good info for everyone. “The foundation of every state is the education of its youth.” by Diogenes.

  20. Simply wanna comment on few general things, The website style and design is perfect, the subject material is very excellent. “Some for renown, on scraps of learning dote, And think they grow immortal as they quote.” by Edward Young.

  21. I genuinely enjoy studying on this web site , it has got great blog posts. “We find comfort among those who agree with us–growth among those who don’t.” by Frank A. Clark.

  22. I genuinely enjoy looking at on this web site, it has got good content. “One should die proudly when it is no longer possible to live proudly.” by Friedrich Wilhelm Nietzsche.

  23. Keep up the good work , I read few blog posts on this site and I conceive that your blog is very interesting and has got lots of great information.

  24. I just couldn’t leave your site before suggesting that I extremely loved the usual info a person provide in your visitors? Is gonna be back steadily to check up on new posts.

  25. You are my intake , I have few blogs and sometimes run out from to post .I think this website holds some rattling good information for everyone. “Drunkenness is temporary suicide.” by Bertrand Russell.

  26. Thank you for sharing excellent informations. Your site is so cool. I am impressed by the details that you have on this site. It reveals how nicely you perceive this subject. Bookmarked this web page, will come back for extra articles. You, my friend, ROCK! I found just the information I already searched all over the place and just couldn’t come across. What an ideal web-site.

  27. I genuinely enjoy reading on this website , it holds fantastic content . “Sometime they’ll give a war and nobody will come.” by Carl Sandburg.

  28. I have been exploring for a little for any high-quality articles or weblog posts in this kind of area . Exploring in Yahoo I eventually stumbled upon this web site. Studying this info So i am glad to exhibit that I’ve an incredibly just right uncanny feeling I found out exactly what I needed. I such a lot for sure will make certain to do not put out of your mind this web site and give it a glance regularly.

  29. I dugg some of you post as I cogitated they were invaluable very useful

  30. I regard something truly interesting about your site so I saved to fav.

  31. Dead written content material , appreciate it for selective information .

  32. Very interesting topic , appreciate it for posting . “I am convinced that life in a physical body is meant to be an ecstatic experience.” by Shakti Gawain.

  33. Gry online says:

    Thanks for sharing superb informations. Your website is very cool. I am impressed by the details that you’ve on this site. It reveals how nicely you understand this subject. Bookmarked this web page, will come back for extra articles. You, my friend, ROCK! I found simply the info I already searched everywhere and just couldn’t come across. What a perfect website.

  34. Great looking website. Presume you did a lot of your very own coding.|

  35. Hey, you used to write fantastic, but the last few posts have been kinda boring… I miss your tremendous writings. Past few posts are just a little out of track! come on!

  36. Thank you for sharing excellent informations. Your web site is so cool. I’m impressed by the details that you’ve on this site. It reveals how nicely you perceive this subject. Bookmarked this website page, will come back for extra articles. You, my friend, ROCK! I found just the info I already searched all over the place and just could not come across. What a perfect website.

  37. The material is extremely interesting.|

  38. Cherie Fonua says:

    Thanks for the sensible critique. Me & my neighbor were just preparing to do a little research on this. We got a grab a book from our area library but I think I learned more clear from this post. I am very glad to see such magnificent information being shared freely out there.

  39. Thanks for the sensible critique. Me and my neighbor were just preparing to do some research on this. We got a grab a book from our local library but I think I learned more clear from this post. I am very glad to see such magnificent info being shared freely out there.

  40. I am going to tools this overview in the direction of 2 designs of Those people: recent Zune owners who are thinking about an update, and us citizens striving in direction of determine in between a Zune and an iPod. (There are other players significance contemplating out there, like the Sony Walkman X, nevertheless I be expecting this offers by yourself ample facts toward deliver an knowledgeable choice of the Zune vs gamers other than the iPod line as perfectly.)

  41. Issac Medler says:

    Fantastic beat ! I would like to apprentice while you amend your web site, how could i subscribe for a blog web site? The account helped me a acceptable deal. I had been a little bit acquainted of this your broadcast provided bright clear concept|

  42. I’m also writing to make you understand what a great encounter my friend’s daughter gained going through your web site. She noticed many details, including how it is like to have a marvelous coaching character to get certain people with ease know precisely a number of complex issues. You really surpassed readers’ expectations. Thanks for coming up with such priceless, safe, edifying and also fun guidance on this topic to Ethel.

  43. experiencing some small security issues with my latest blog, and I’d like to find something safer. Do you have any suggestions?

  44. Nancy says:

    I am realy incredibly delighted to visit your blog site. Now I am located which I essentially want.

  45. ???????????????????????????????????????

Leave a Reply