Transparency in Hospital Safety: A case study of ‘what it takes’ for hospitals to complete the Leapfrog Group Hospital Survey

Background: In pursuit of increasing consumer utilization of hospital safety information, The Leapfrog Group (LFG) asks hospitals to voluntarily self-report information through a survey after which LFG assesses responses’ achievement to LFG standards and publicly posts the hospital’s achievement levels. A substantial number of hospitals do not participate, including vast majority of Oklahoma hospitals. A potential barrier is that administrators lack information to estimate “what it takes” to participate. Therefore, we measured a first-time effort and experience of LFG survey participation.

Method: Researchers at Oklahoma State University Center for Health Systems Innovation conducted a field study to discover what it took in personnel, project management, time, and effort. We directly supported first-time participation of a 199-bed hospital by providing them with a 0.25 FTE project manager and recorded the associated effort, barriers, and benefits. LFG supported this effort with access to technical support at no cost.

Results: We found that 12 people dedicated 117 hours which was in addition to the project manager’s time and the majority of those people were department heads. Multiple LFG standards do not align perfectly with other accrediting bodies, meaning that specific changes would need to be made in order to score highly on several sections. The survey’s Section 2 required a disproportionately high number of hours due to the 40 hours needed for medicine reconciliation assessment. The CEO estimated that fully committing to achieving the LFG standards year-round would require $325,000 to fund additional nurse FTEs. Our processes used to complete the survey and barriers encountered are included. Of particular interest for administrators, we share how the volunteer survey is connected to LFG’s other posted hospital rating, the hospital safety grade which is calculated with or without survey participation.

Conclusion: The process takes significant time from leadership and committing to achieving the LFG standards would require significant funding. The immediate benefit was that departments used the survey to identify easy-to-achieve, 90-day quality assurance improvement goals. The CEO did not submit this first survey response, instead embracing it as preparation for possible subsequent participation.