Hospitals - How do they differ?

Some people think that hospitals all provide approximately the same level of service and that their outcome will be the same regardless of which hospital they use. A recent study of the top hospitals would suggest that hospitals differ widely in their performance just like other service organizations.

Mortality, patient complications, length of stay, cost per discharge, and profitability all vary even after adjusting for severity of the cases treated. Although hospitals vary in their performance, the problem for the average consumer is identifying the differences that really matter.

The real questions are how do hospitals differ in ways important to you and how can you compare hospital performance. The most important consideration for you, the patient or parent, is how well they will take care of you or your child. As in choosing a doctor, experience with conditions like yours is probably the most important factor. You want a hospital that deals with your medical condition often enough to know what should be done.

Experience also helps them recognize their limitations. For pregnancy, you want to know how many normal and high risk deliveries occur at a hospital. For problems with your infant, you want to know how often they treat sick infants and if they have a newborn intensive care unit (NICU).

The Importance of Volume
It is very important. For example, recent studies have shown that receiving angioplasty from an experienced physician and hospital team lowers the risk of death and complications. Another study looked at mortality among preterm infants born in New York City. Preterm infants had a 24% higher mortality rate if they were not born at tertiary centers, which are the best equipped and most experienced at dealing with sick, premature infants. The less sophisticated centers would not be expected to deal with very preterm infants on a regular basis. Similarly, another study showed that infants not born in a tertiary centre had a higher mortality and more complications than those who were. There have been conflicting studies about this issue, and many other variables influence mortality at a particular hospital. However, a hospital’s experience in dealing with preterm or sick full-term infants makes a difference in the quality of care they can provide for those infants.

Idiosyncrasies
The doctors, nurses and other staff in the hospital determine the character and 'feel' of a hospital. Sometimes just walking thru the halls will give you a feeling that the hospital is concerned about its patients. In others, one gets a cold and aloof feeling. The personnel of a hospital make a large difference in the care you receive.

For example, caesarean section rates among hospitals vary even after adjusting for differences in the types of patients they treat. Some of this is due to subtle differences among patients, but it is also related to the practice styles and habits of the physicians and personnel. The national average for caesarean section is 20.8% (1995 data). The rate of epidural anesthesia also varies by hospital. Epidural anesthesia is thought by some to increase the length of labor and to increase the likelihood of a caesarean section or the need to use forceps. Many hospitals keep statistics on the rates of these interventions. Just knowing that the hospital monitors these interventions says something about their commitment to quality. Interpreting the statistics is beyond the ability of many professionals and most lay people. However, if epidural anesthesia is a major concern, you can ask for the data and ask your doctor or midwife to help you understand it.

Baby-Friendly Hospitals
The percentage of mothers who successfully breastfeed their infants varies among hospitals. Part of this variation depends on the practices of the hospital where the baby is born. The World Health Organization (WHO) encourages breastfeeding in all nations as a way to improve the health of babies. WHO has developed ten criteria for awarding hospitals the Baby-Friendly designation. Hospitals that do not meet these criteria are not 'Baby-Unfriendly' they just have not adopted the recommendations of the WHO. The hospital you choose can make a difference in how successful you will be in breastfeeding your baby. If this is important to you, ask your doctor about it.

Meeting Hospital Personnel Before Delivery
Many hospitals sponsor 'getting acquainted' events that allow you to meet doctors and nurses before you are admitted in labor. You can obtain some idea of the style and approach of the doctor and other personnel at these meetings. Try asking a few questions and see how they are answered.

Insider Information
You might call the Labor and Delivery service of the hospital and ask them a few questions. The tone and attitude of the answers will probably reveal more about the hospital than the actual answers. Ask them about any issues that are important to you. Examples might be support of breastfeeding, the availability of a lactation consultant, use of epidural anesthesia, use of labor/delivery/recovery suites, etc.

Financial Arrangements
Finally, hospitals can vary in the charges for their services and how much of that charge will be paid by your insurance plan. If you are likely to pay a percentage of the charges before your insurance coverage begins, you should know what your costs will be. You must know what your insurance plan includes and should talk with the business office of the hospitals you are considering. This area is very confusing. Talk with your benefits manager, review your policy, and speak with someone in the hospital business office to make sure you have your facts straight.

Plainly Speaking
Identifying differences in hospital quality is difficult for patients. There are several sources of information that you can use to know more about your hospital. Knowing someone who works in the medical area remains the best way to know which hospital provides the best service in your area.

Also see >Choosing a hospital