Making Diversity Count in Every Hospital

Three experts in hospital quality say it’s time for hospital ratings to include broader metrics that truly reflect what it means to serve a patient population.  

In the past month, the Centers for Medicare and Medicaid Services and U.S. News & World Report released the 2016 hospital quality ratings. These ratings are designed to help consumers decide where to receive care. Hospital quality ratings are derived primarily from publicly available data, such as mortality rates, hospital readmission rates, hospital-acquired infections, and patient satisfaction scores.

While some health care providers have expressed methodological concerns regarding various aspects of hospital quality rating systems, most agree that measurement is the foundation of improvement. Done well, measurement helps us to focus our resources on the tasks critical to providing the best and safest care. Done poorly, measurement can create perverse incentives for health care providers—manifested, for instance, when physicians overprescribe opioids in an effort to improve pain management ratings. Moreover, things that are not actively measured may be ignored, to the detriment of patients.

One element that is noticeably absent from major hospital rating systems is diversity. The best hospitals in the nation cannot claim to be best if they cannot effectively provide inclusive care to everyone. A legacy of great medical centers is the mission to serve the entire population, regardless of sex, race, religion, ethnicity, sexual orientation, gender identity, economic status or any other factor.

Why is diversity in health care so important? The answer is simple: anyone can get sick. The degree to which a hospital serves a diverse population reflects its ability and willingness to provide excellent care despite a range of challenges.  A hospital that is tuned to diversity and inclusion has the reserve and the resolve to help all patients, regardless of the risk to its ratings. A hospital that is tuned to diversity has figured out how to deliver exceptional care instead of how to merely select cases that boost finances and rankings.

As a first step, we can encourage entities that rate the quality of health care to include a diversity metric. Consumers should be informed about the proportion of Medicaid patients seen by a hospital, as well as the proportion of patients who are dually eligible under the Medicare and Medicaid Programs. The amount of charity care delivered by a hospital could also be included in hospital ratings.

We can and should also measure a hospital’s diversity among patients, staff, and leadership in terms of race, ethnicity, sex, sexual orientation, gender identity, veterans’ status, and other dimensions of diversity. Hospital staff and leadership ought to be representative of the population they care for. U.S. News already employs a diversity index in its higher education ratings—why not do the same for hospitals? The American Hospital Association, along with the American College of Healthcare Executives, America’s Essential Hospitals, and the Association of American Medical Colleges have partnered in a National Call to Action to Eliminate Health Care Disparities. This effort calls upon hospitals to increase the collection and use of race, ethnicity, and language preference data; increase cultural competency training; and increase diversity in governance and leadership. Many hospitals have already pledged to support this important cause.

William Bruce Cameron famously wrote: “Not everything that can be counted counts. Not everything that counts can be counted.” Diversity in hospitals definitely counts, and it should be counted in ratings of hospital quality.

Henry Ting, MD, MBA, is an Academy Fellow Ambassador and a Senior Vice President and Chief Quality Officer at NewYork-Presbyterian; David Vawdrey, PhD, leads NewYork-Presbyterian’s Value Institute and is an Assistant Professor of Biomedical Informatics at Columbia University; George Hripcsak, MD, MS, is Chair of Biomedical Informatics at Columbia University and Director of Medical Informatics Services at NewYork-Presbyterian Hospital/Columbia.