Every hospital and health system wants to provide its patients with the best possible care. By being transparent about quality and safety data and reporting to the annual Leapfrog Hospital Survey, hospitals and systems can demonstrate how they put patients first.
Over 2,200 hospitals report annually to the Leapfrog Hospital Survey, representing 75% of inpatient beds. It is the nation's gold standard in pursuit of excellence in health care quality. This is the fourth in a series of case studies of hospitals and hospital systems selected as exemplars for using Leapfrog as a tool for improving care for patients and the community.
One Health System’s Journey to 100% Transparency
Allegheny Health Network (AHN) recently took an important step to demonstrate to its community a commitment to 100% transparency. AHN was formed in 2013 and is an integrated healthcare delivery system serving the greater Western Pennsylvania region. The Network is composed of 12 hospitals, ambulatory surgery centers, health and wellness pavilions, multiple employed physician organizations, home and community based health services, a research institute, and a group purchasing organization. Highmark Health is AHN’s parent company.
“Our leaders have always focused on putting patients first and providing the safest, highest quality care,” said Brian Parker, MD, Chief Quality Officer, AHN. “Reporting to the Leapfrog Hospital Survey was the next logical step for us.”
Leaders at AHN had discussed participating for years. But in spring 2019, Highmark Health and AHN’s Boards of Directors decided now was the time for AHN hospitals to fully commit.
“Our Board does what a good Board should do – they challenge our leadership to meet the demands of our community including the patients we serve and the employees within our organization. They challenged us to have 100% system-wide participation in the Leapfrog Hospital Survey and that’s what we are working toward,” Dr. Parker said.
During that time, there was a significant shift in the marketplace in Western Pennsylvania which placed a renewed emphasis on external ratings systems, including Leapfrog, and the role ratings systems can play in improving quality and safety of health care.
Some of the other reasons AHN decided to work toward system-wide participation include being able to benchmark and compare performance across its hospitals as well as to show purchasers and consumers in their community that it is committed to transparency.
Putting in Place the Processes for Participation at the System Level
AHN had a number of building blocks in place before it started the Leapfrog journey. It had established solid quality, patient safety, risk management and EHR processes across its 
system that helped prepare it to submit the Surveys and to do well.
System leadership conducted extensive due diligence regarding the Survey; assembled a strong interdisciplinary team of clinical and administrative leaders to guide the work; and established a robust, standardized data collection and validation process that each hospital used to vet and submit its data. This approach leveraged the strength of the system to support individual hospitals and garner significant results.
“The internal processes we put in place were critical for not only submitting each Hospital Survey, but also providing a clear line of sight for each hospital leader to see exactly what the data were and how their performance compared across the system and to hospitals nationally. This had an enormous impact on morale and helped make every hospital leader be even more committed to Survey participation,” said Kelly Glass, Vice President of Enterprise Clinical Quality for Highmark Health.
Being able to see each hospital’s results and share them with frontline workers helped boost staff morale across all levels of hospital staff, especially nurses.
Audra Balla, RN, at AHN said, “I have a lot of pride in knowing that we, as an organization, continue to put forth effort to improve patient outcomes, standardize care, and change practice for the betterment of our patients and to ensure their safety. We prioritize our patients’ safety because it is of the utmost importance to us. The Leapfrog Survey Results show that we put our community first and advocate for our patients. I know that we will continue to put forth our best effort to keep our patients safe, because our patients rely on us to give the best care.”
Using Leapfrog Hospital Survey Results for Quality and Safety Improvement
AHN leaders use the Leapfrog Hospital Survey as feedback for continuous process improvement across the system.
The Computerized Physician Order Entry (CPOE) Evaluation Tool, which is part of the Hospital Survey, was of particular value to AHN. CPOE is one of The Leapfrog Group’s original quality and safety standards. Hospitals are asked to report on their use of this technology to reduce and prevent medication ordering errors, as well as to participate in a simulation test that evaluates if those systems are alerting providers to potential errors.
Each hospital passed the CPOE test, but still learned about alerts that were being triggered at the wrong times. This helped improve their CPOE system across the network. Because approximately 90% of medication errors occur during manual ordering and transcribing (handwriting and interpreting the prescription), the use of CPOE systems is critical to eliminating these types of errors.
AHN included its IT teams in the CPOE testing process, as well as physicians and pharmacists, to make system-wide CPOE changes as it identified issues during the testing process.
“Our Survey results provided a new level of transparency for us both internally and externally to consumers, purchasers and payors in our community,” Dr. Parker said.
“Participating in the Leapfrog Hospital Survey positioned us better in our local market and also improved morale across staff at every level within our system who received validation for their hard work.”
After participating in the Leapfrog Hospital Survey, many of the Leapfrog Hospital Safety Grades for their individual hospitals also improved. This doesn’t always happen, and in fact hospitals that participate in the Leapfrog Hospital Survey get every Grade – from “A” to “F.” But by reporting to the Leapfrog Hospital Survey, it gives Leapfrog more and better data on which to calculate their Safety Grade.
In AHN’s case, 6 of its 8 graded hospitals improved two letter grades between Spring 2019 and Spring 2020 and all 8 ranked at an “A” or “B”.
| Hospital Name | Spring 2019 Grade | Fall 2019 Grade | Spring 2020 Grade |
|---|---|---|---|
| Allegheny Valley | D | C | A |
| Forbes | C | B | A |
| Grove City | B | A | A |
| Jefferson | C | B | A |
| West Penn | C | B |
A |
| Allegheny General | D | C | B |
| Canonsburg | B | B | B |
| Saint Vincent | D |
C |
B |
“This was announced in April 2020 which aligned with our state allowing elective surgeries to take place again after they were halted due to the COVID-19 pandemic. It was important to us that consumers, purchasers and payors felt safe coming back to our hospitals, so we launched a marketing campaign showcasing our “A” ratings that was very successful,” Dr. Parker said.
“Now we can market to our community and to payors that we have a network of high-performing, safe hospitals. This has made a huge difference,” Glass said.
“We are going to continue to utilize Leapfrog’s standards as a key component of our system-wide quality and safety work,” Glass said. “Through Leapfrog, we’ve also had the chance to meet other system leaders who are on a similar journey. They’ve helped us and we’ve been able to help them too through sharing best practices. This has been invaluable to us.”
Like AHN, many large and small health systems across the country engage all hospitals in their system in completing the Leapfrog Hospital Survey. By securing participation from all facilities, health system leaders can easily benchmark performance, identify high and low performers, and demonstrate their value to employers and purchasers in their community. Leapfrog offers several tools to assist health systems in their completion of the Leapfrog Hospital Survey and in their analysis of results, such as aggregated data files and customized benchmarking reports.
About the Leapfrog Hospital Survey
Purchasers and national health plans request that all general acute care and pediatric hospitals in the U.S. complete the annual Leapfrog Hospital Survey, and reports those that opt out as “declined to respond.” Leapfrog also publicly reports information about Hospital Outpatient Departments and ambulatory surgery centers (ASCs) through the Leapfrog ASC Survey. Results compare quality and safety. Results are reported by hospital and used for public reporting and payment strategies.
Reporting to the Survey is free for all hospitals and the results are free to the public on Ratings.LeapfrogGroup.org.
For more information on completing the Leapfrog Hospital Survey visit www.leapfroggroup.org/hospital.