U.S. News & World Report recently released its eighth annual Best Children’s Hospitals rankings, a guide to the best care for children who face life-threatening, or complex conditions or procedures. With various changes in the methodology behind the new ranking, it leaves some hospital leaders wondering, what areas do we need increase our focus? We distilled the highlights from the methodology report in this concise overview…
Overview of Survey Changes
In a nutshell, the biggest change that occurred with the U.S. News and World Report Best Children’s Hospitals Survey was an increased emphasis on best practices and infection, with certain specialties being impacted more heavily as additional outcome measures were added in Neonatology, Orthopedics, and in Gastroenterology & GI Surgery.
The degree to which hospitals will be impacted by these changes varies based on the hospital’s positive, or negative, outcomes in the new categories measured; and how effective they have been at adopting best practices and minimizing infections. As anticipated, the greatest overall ranking increases and decreases occurred within the four specialties, which experienced changes not only in the process category, but also in the outcomes and structural categories. For Neonatology, Orthopedics, Gastroenterology and GI Surgery, and Diabetes and Endocrinology, a hospital could be expected to move either upward or downward twelve rankings. In the remaining six specialties, the median shift in rankings ranged from four to eight.
Survey Respondents
A total of 183 pediatric hospitals were surveyed, with 116 hospitals providing an adequate amount of data to be evaluated, for a response rate of 63.4%. Of these hospitals, 89 ranked in the top 50 in at least one specialty category. Roughly one-fourth of the hospital respondents are freestanding facilities with the remainder being major medical-center pediatric departments that function as a hospital within a hospital. The only additional respondents were Oncology or specialty-specific hospitals that were well-known throughout the country.
Methodology
The pediatric specialty categories evaluated were Cancer, Cardiology and Heart Surgery, Diabetes and Endocrinology, Gastroenterology and Gl Surgery, Neonatology, Nephrology, Neurology and Neurosurgery, Orthopedics, Pulmonology, and Urology.
The survey was split into three categories (outcomes, process, and structure) each receiving equal weighting of 33.3%:
- The Outcomes category measures infection prevention, surgical complications, and survival rates.
- The Process category consists of three items: reputation, 16.7%; compliance with best practices, 8.3%; and infection prevention, 8.3%.
- Structure includes the resources and services available to patients and their families.
All of the measures are self-reported by the pediatric hospital respondents, with the exception of the process reputation score. This is gathered via 1,500 randomly conducted surveys, 150 per specialty, in which respondents are asked to name up to 10 hospitals they consider among the best for children with serious or difficult medical problems. The reputational rankings are averaged for the three most recent years. In the 2014 survey, more than 46.5 percent of the physicians contacted responded to the survey.
Detailed Changes
The two primary changes that occurred from the 2013-2014 survey to 2014-2015 survey were 1) the reputational weighting decreased from 25% to 16.7%; and the weight assigned to the best practices and infection-prevention categories doubled to 8.3% each; and 2) new outcomes measures were added in the specialties of Neonatology, Pediatric Orthopedics, Pediatric Gastroenterology and GI Surgery.
The overall outcomes category still accounts for 33.3% of the total score, however the weighting of the individual elements, within the three impacted specialties, decreased to allow for the inclusion of new measures.
| Specialty | New Outcome Measures |
| Neonatology | Assessing the rate of readmissions to the NICU within 30 days of discharge (for those admitted to the NICU within 7 days of birth); Documenting that neonatal feeding needs are being met by human breast milk |
| Orthopedics | Addressed the efficient and successful treatment of complex fractures |
| Gastroenterology & GI Surgery | Complications occurring in endoscopic procedures; Successful use of the Kasai procedure; Prednisone-free remission following treatment for inflammatory bowel disease. |
For all specialties, the prevention of ICU infections is now evaluated on a 5-point scale versus a 3-point scale to minimize year-over-year fluctuations in ICU infections.
The only structural category change that was made entailed removing the diabetes care option question from the Diabetes and Endocrinology specialty scores since care options are determined upon the type of patient’s insurance.
Conclusion
It’s very clear that U.S. News & World Report is aligning its methodology with the healthcare reform, putting greater emphasis on outcomes and quality—as it should. To improve rankings over the long term, hospitals need to galvanize its clinical and hospital leadership to prioritize improvements in these important areas of patient care. However, these initiatives often take a lot of resources and time to build momentum.
On the other hand, marketers have a more immediate opportunity to impact ranking scores through reputation building. While the reputation score was reduced from 25% to 16.7%, that is still a significant portion of the overall score for each specialty. Marketers can support rankings initiative through targeted and consistent reputation marketing to peer physicians in each of the ranked specialties. What’s more, reputation marketing can have a halo effect to improve referral volumes, medical tourism to your children’s hospital, and recruitment efforts. This is a win-win for the entire organization.