Healthcare experts find community hospitals have many advantages

(Monroe, WI)— The phrase “bigger is better” may not apply to many healthcare situations, according to Dr. Donald M. Berwick, leader of the Institute for Healthcare Improvement in Cambridge, MA. In his position, Berwick is a prominent advocate and influential voice for healthcare quality as his organization worked with 4,000 hospitals throughout the United States to significantly reduce medical mistakes and improve healthcare quality.

Berwick’s view on community hospitals vs. larger, teaching hospitals was the topic of an article featured in the Boston Globe on December 28, 2008. The article, written by Marcella Bombardieri and titled “Are the elite academic hospitals always a patient's best choice?” found a growing number of healthcare specialists feel that despite popular perception, in many cases patients will benefit from staying close to home. In the article, Beswick stated that when it comes to most common healthcare services “you would be better off at a caring, smaller community hospital that's taking quality seriously than in a massive, complex teaching hospital that's taking quality seriously.”

While Berwick suggested teaching hospitals are a good choice for certain illnesses that require rare operations or less routine treatments, he has gone on the record to say that teaching hospitals also have their share of disadvantages. The article also stated “Berwick's point of view is gaining currency among other prominent doctors and researchers, who believe that teaching hospitals can be too busy handling all manner of complex care to always get the basics right, or that community hospitals have worked harder to improve quality in recent years than their academic counterparts.”

While researching the comparison can be difficult due to the difference in patient levels, conditions and services, the article discussed recent efforts to offer comparative measures between community and academic hospitals. The article stated, “In one example, Sir Brian Jarman an emeritus professor at Imperial College in London, has developed a method to calculate the death rates of entire hospitals in a way that they can be compared, despite differences in how sick the patients they see are. Jarman found that in 2000, 39 elite academic hospitals in the United States had a lower death rate than all other hospitals in the nation. By 2006, however, the situation had reversed. Both kinds of hospitals had seen their mortality rates decline significantly, but the elite hospitals now had a higher death rate than the rest.”

On a local level, statistics appear to reinforce the notion that community healthcare providers, such as Monroe Clinic, have many advantages to offer patients. For instance, the U.S. Department of Health & Human Services “Hospital Compare” tool—available at hospitalcompare.hhs.gov—offers the public a chance to compare quality measures and outcomes of healthcare providers within their region. When compared to its larger, Madison-based counterparts, on most points Monroe Clinic rated as good or better. For instance, under “Pneumonia Process of Care Measures” Monroe Clinic was rated higher than UW Hospitals and Clinics in seven out of seven care measures.

“We have a distinct advantage of being a community healthcare provider that is large enough to have the resources, technologies and skilled caregivers on hand to offer a wide range of services. Still, we are small enough to pay attention to the basics—which can make a significant difference in our patients’ health,” said Dr. Mark Thompson, Chief Medical Officer at Monroe Clinic.

Thompson also said that being a community healthcare provider also offers a motivating perspective as the caregivers recognize patients are individuals with lives that extend far beyond their medical files.

“In many cases, our family members, friends and neighbors are placing their health in our hands,” said Thompson. “I can’t think of many situations that are more humbling or more inspiring than the show of trust our patients offer us each day.”