Assessing the Impact of a Public Report on Hospital Quality: A Controlled Experiment in the State of Wisconsin

Grant Description: How do hospitals react to public reports of their quality and how do such reports influence consumers’ perceptions of hospital quality? This study, conducted by researchers at the University of Oregon, assessed whether public reports of quality lead to improvement efforts within hospitals. The researchers also studied whether the public reports created a general impression among consumers about the quality and safety of hospitals in the community. The researchers worked with The Alliance, a large purchasing group based in Madison, Wisconsin, that disseminated the public report. The researchers conducted a controlled experiment in which hospitals were assigned to one of the following three groups. Hospitals in The Alliance, 25 in the region surrounding Madison, were included in the public report. The remaining 100 hospitals in Wisconsin were separated by size (large and small) and randomly assigned to either the other treatment group or the control group. The second treatment group received a report of their own performance compared with other hospitals that was not made public. The control group did not receive any reports. The objective of the study was to assess whether public reporting of hospital quality motivated improved behavior and performance and how public reporting affects consumer perceptions of hospital quality.

Policy Summary: In this study the researchers assessed the short and long-term impact of a public hospital performance report on both consumers and hospitals. Hospitals featured in a public performance report were compared with other hospitals that were randomly assigned to receive a private confidential performance report or no report. The findings indicate that making performance public results in improvements in the clinical area reported upon. These improvements were substantially greater than those observed in the private report group of hospitals or among the hospital who received no report. Hospitals included in the public report appeared to be motivated by the belief that the report would affect their public image. And indeed, the evidence from the consumer surveys suggests that the report did affect hospital reputations. The findings provide substantial evidence that making performance public stimulates long-term improvements beyond the improvements stimulated by private reports. The hospitals that improved their performance were much more likely to engage in a wide range of increased improvement efforts immediately after the report. In other words, the actual improvement gains appear to be linked to quality improvement efforts that began in the immediate post-report period. To maximize the value of public performance reporting strategies, it is critical that they effectively address the factors that actually motivate hospital quality improvement. Hospitals appear to be motivated primarily by concerns about protecting or enhancing their public images and less so by immediate market share concerns. Reports that are difficult for consumers to understand or use are not going to enhance or threaten any hospital’s reputation. Only reports, like the QualityCounts report, that make it very explicit for consumers which hospitals are top performers and which ones are not are likely to achieve the results observed in this study. Even though the most common approach to motivating improvement is the provision of private reports and the reliance on professional norms, it appears to be a less effective stratagem than making performance public. The findings indicate that if public reports were designed and disseminated in the same way that the QualityCounts was, it would yield a significant positive impact on quality improvements in hospitals.