Patients At Risk: Leapfrog Group CEO Leah Binder on High Rate of Avoidbable Deaths in America’s Hospitals

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Marianne O'Hare : Welcome to Conversations on Health Care with Mark Masselli
and Margaret Flinter, a show where we speak to the top
thought leaders in health innovation, health policy, care
delivery, and the great minds who are shaping the healthcar e
of the future.

This week, Mark and Margaret speak with Leah Binder CEO of
The Leapfrog Group dedicated to improving patient safety in
America's hospitals. They just released the latest report on the
number of preventable deaths in American hospitals a 16 1,000
last year alone, which is actually an improvement from the
quarter million just a few years ago t o talk about the hospital
safety grade scorecard , and look at what leads to hospitals
having for scores and outcomes.

Lori Robertson also checks in , Mana ging Editor of
FactCheck.org, looks at misstatements spoken about health
policy in the public domain, separating the faith from the facts.

We end with a Bright Idea that’s improving health and well -
being in everyday lives. If you have comments, e - mail us at
[email protected] or find us on Facebook, Twitter, iTunes,
or wherever you listen to podcasts. You can hear us by asking
Alexa to play the program Conversations on Health Care.

Now , stay tuned for our interview with Leah Binder of The
Leapfrog Group on Conversations on Health Care.

Mark Masselli: We're speaking today with Leah Binder , President and CEO of
Leapfrog Group, an independent nonprofit organization
dedicated to improving safety and quality in American h ospital
care. Ms . Binder also launched the Hospital Safety Grade
which just released its latest report on hospital safety across
the country including the number of patient deaths due to
medical errors . She has repeatedly been named to modern
healthcare's hundred most influential people in healthcare.
She earned her bachelor's degree from Brandeis University
and two master's degrees from the University of Pennsylvania
in communication and government. Leah, welcome back to
Conversations on Healthcare .

Leah B inder : Well, thank you for having me. It's great to be here.

Mark Masselli: Yeah . It's four years now since we talk ed with you. We
discussed the prevalence of deaths in American hospitals due
to preventable causes , and it's really a staggering amount,
quar ter of a million deaths per year. Leapfrog has joined forces
again with Johns Hopkins Institute for patient safety . You've

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just released some new numbers and certainly , there's been
an improvement , estimated 160,000 deaths. I'm wondering if
you could share with our listeners the most revealing data
from your report and why this problem still persists.

Leah Binder : Right. There's good news and there's bad news. The good
news is that we have fewer avoidable deaths in hospitals. We
have 161,000 attributed to m easures in our Hospital Safety
Grade . It's not actually all errors and accidents that can
happen in hospitals, but it's the ones we can measure. It's
fewer than when we measured it three years ago. I mean
that's specifically 45,000 people who are alive tod ay who
might've died last year from something that was avoidable , so
that’s good news . Great n ews actually is that for many years,
so many people have been really trying hard to improve the
problem of patient safety but we never ever see our results , so
s e eing this is positive and powerful . But of course the bad
news is 160,000 people , I mean that is a big number , t hat is
500 people a day. That's a really terrible problem , and it's
completely solvable. These are just accidents and errors. These
are not thin gs that cost a lot of money to solve either. I mean,
a hospital just need to follow rules. Everybody works there has
to wash their hands. Everybody has to be vigilant an d careful
about the patient 24/7 . It's not easy to do that, but it is not
expensive and it's not impossible.

Margaret Flinter: Well Leah, as you say, 160,000 deaths is far too many. We
know that the known causes, the surgical errors, the medical
mistakes, medication errors, but your research reveals that a
poor or a failing hospital score is a pretty good indicator that a
patient is more likely to experience a medical error or a deadly
mishap. So t alk with us about how these hospitals scores are
compiled , and really how do they act as a important guidepost
for consumers seeking the best possi ble outcomes in their
care. And a lso , are they a truly highly motivating factor in
getting organizations and their staffs to change their behavior?

Leah Binder: Yes, they are motivational. We have seen some incredible
efforts by hospitals to get that A, an d so I want to give credit
to the hospital community where that is happening. We are
seeing enormous will and leadership brought to the table to
really improve perform ance of hospitals and get that A . We
know for all having been kids, most of us have had h ad get a
letter gra de.

Margaret Flinter: Yeah.

Leah Binder: You know how motivationa l it can be when you get that A B C
D or F , and it really is motivational. We have 28 different

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measures of safety. We're looking at errors and infect ion
rates, never event s rates, s o things like leaving a sponge and
aft er surgery u nfortunately some of those terrible things do
happen and we know when they happen. We also look at how
they prevent those events. Do they have in place t he right
systems that are known to keep pat ients safe ? For example,
do they use an electronic system for prescribing drugs? That is
the most common error made in hospitals is problems with
medications. Imagine how easy it is to give someone a much
higher dose than they should get. Electronic prescr ibing
systems can prevent 40% or more of those from happening , so
w e're looking at those things .

When we asked John Hopkins to look at, well what's the death
rate and what's the problem in A versus B versus C versus D
and F hospitals? We want to know , are we actually showing
that there is a difference? Because if there's no difference, we
don't have the right method. The method we use from three
years ago showed that there was major difference in the death
rate between the different letter grades , and this year the
difference is even more compelling than we found originally.
Your chances of unavoidable death , getting killed in a D and F
hospital is 92% greater than if you go to an A hospital , s o
almost twice as likely to die of an error or an infection.
Actu ally you're 88% more likely to die in a C hospital than in A
hospital. Even the C hospitals show signific antly poor
performance than in A hospital, and B hospitals also were
more likely to die, not as bad. The letter grade is relevant and
everybody should really pay attention to it and also pay
attention to it every six months because hospitals change. I'm
amazed and impressed by how much effort hospitals pu t into
getting that A , and they show results.

Mark Masselli: Leah, I am still trying to get my head a round the 500 per day.
That's a staggering amount. You have lots of people who
weren't dead but were obviously caused enormous harm. Talk
about the broader problem of patient harm and why that's so
hard to track.

Leah Binder: Well, the problem with patient safety as it tends to be
invisible. Typically we -- the way that we understand what's
actually happening in healthcare and measure the quality is by
billing data, which isn't exactly perfect. Billing data is meant to
get hospitals paid, not to figure out how high quality service
they're delivering. So a patient's safety is particularly difficult
to track through billing data because typically hospital does
not send a bill saying , oops the reason that's so high as, we
made a big mistake . It's not going to s ay, oh, there was a

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surgical site infection , t hat's why the patient was there for a
month in the hospital or something. It's very hard to find a lot
of these problems and errors. The reason we have better data
now is because there've been many efforts to b e better about
it. There is now data coming out of CMS, which is the agency
that runs medicare that requires hospitals to report their rates
of different kinds of errors and infections , and t hat's where we
get data. We also have to ask hospitals cause ther e's lots of
things we don't know, they know. Leapfrog actually asks them
to give us some data as well to help us to better understand
infection rates and things like that. Hospitals giving us that
data on their own is really what is ultimately going to tel l us
where the safety problems are.

Margaret Flinter: Well Leah , I think it's really important to note these aren't,
arbitrary criteria. I think you've made that point really clearly
and I think people can therefore take some real confidence in
it. I have a bit of a two part question : o ne , you mentioned a
couple of the measures and I wonder if you might just mention
a couple of more , y ou talked about electronic prescribing , just
to give our listeners or a more robust understanding . I have a
part two to that , i n the primary care domain, we are always
factoring in the impact of th e social determinants of health of
poverty and literacy levels, education levels. Is there any
factoring in of the social determinants when you are looking at
this issue of preventabl e deaths in the hospital setting?

Leah Binder: Socioeconomic factors have a major impact on health systems
and their ability to deliver top quality care. People's lives can
be more complicated depending on where they live and
depending on their poverty. Th ere's clearly a need to
recognize the differences in socioeconomic factors that can
affect the performance of a health system. However, that
should not change how we calculate performance. If a hospital
is serving, we call it a safety net hospital, a commu nity that is ,
le t's say largely on Medicaid. If that hospital has a high death
rate, we should still say you have a high death rate. We should
also recognize and say , there are factors that contribute to
that. There's ways that we can talk about the factor s without
having to say , we're going to report you as a lower death rate
because your population is in poverty. That is not okay. We
have to be very, very car eful I think as we look at quality
measurement nationally that we don't erase people's lives and
s ay, well, we expect that because they' re poor. We are looking
only in our grades A, B, C, D and F only at errors and accidents,
infections and injuries. We're only looking at those factors and
most of those are not affected by demographic factors per se ,
o ne of the measures we look at is objects left in after surgery,

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so sponges left in accidentally. It doesn't matter if the patient
is rich or poor , a sponge should never be left in ever. We're
looking at things that hospitals can control, they can make
sure that they order medications correctly and make sure they
get it to the right patient at the right time. Those are factors
that we look at. We also look at what happens at the bedside ,
if they have the right systems in place for making sure that the
right med gets to the right patient, which is also a problem.
We look at coverage in the ICU making sure that there's a
certified intensivist physician that can sav e lives by enormous
factors. Those kinds of things aren't affected by the hospitals
putting a high priority on safety.

Mark Masselli: We're speaking today with Leah Binder , President and CEO of
Leapfrog Group, an independent nonprofit organization
dedicated to improving safety and quality in American hospital
care . Ms. Binder launched the Hospital Safe ty Grade, which
just released its latest report on how hospitals scored across
the country. You know, Leah , I was looking at the report and
th
I'm going to move out of Connecticut. We're ranked 40 and I
might well move to Washington State, which came out on top.
Tell us how the state rankings are compiled , and are there
other factors that go into that?

Leah Binder: Well, we do state rankings based on the percentage of
hospitals in a state that earned an A from us. I would say
Connecticut has been a concern. They have not been ranked
high ever on our list of states , and they should be that is a
state with some very significant hospitals. They are often
pioneers and innovators. I'm very happy that you have great
innovations, but when I walk in your hospital or my loved one
does, don't give me an infection , t hanks. New York , I'm just
frustrated with New York because that's a state and the city,
particularly New York City , where so much of the next
generation of healthcare providers are being trained and yet
their performance on safety is terrible. Whereas New Jersey,
that's one of the top states in the country, they've consistently
had very high percentage of As , and I think they're number six
as a state. Maine has been in the top five really since we
started grad ing hospitals. So there's real variation in states and
a lot of it has to do with hospital associations. I've seen some
great leadership from hospital associations in different states
that are really put an emphasis on safety and really brought
together le aders from different hospitals, including CEOs to try
to share best practices and share some of their data with each
others. So I think there's certainly very positive and promising
results in states where they do have strong leadership from
the hospitals.

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Margaret Flinter: Well Leah, I wonder if I could get you to comment on another
area that is of real concern to us, and that's what we're seeing
with maternal death rates. Our maternal death rate is higher
than the other industrialized countries. But also I know that
the Leapfrog Group has been engaged for a number of years in
a particular campaign to influence hospitals and expectant
mothers and clinicians to reduce the number of planned early
C - Sections. Could you talk about the larger issue of what
Leapf rog is looking at or thinking about relative to maternal
death , and also the impact of your specific campaign and how
that perhaps has influenced outcomes?

Leah Binder: The Joint Commission, which is the accrediting organization
that accredits the majority of hospitals in the country , I think
they are about to finalize a measure that hospitals will be
expected to adhere to on procedures they need to take to
prevent maternal mortality. So I'm certain that the Joint
Commission will not make that public by hos pital, but Leapfrog
can . We ask hospitals to voluntarily give us information we
can't get and that will certainly be something we will look at to
ask hospitals to give us what they gave to Joint Commission on
whether they're complying with that because we agree it's
disgraceful actually that our country has the highest rate of
maternal death. There's just no excuse for that. This must
stop , and I know we can stop this because we have done a
great job in stopping another problem which you alluded to
earlier, which is early elective deliveries. These are deliveries
that are scheduled without a medical reason prior to 39
weeks. So prior to when Mother Nature says this is when the
babies to be born, they schedule them , and ACOG , which is a
organization for obste tricians and gynecologists as well as
leading authorities like March of Dimes have said , don't do
these deliveries. They're not safe for the babies, they’re not
safe for the moms. The NICU are populated too often with
babies that come from these early elec tive deliveries.

So we started reporting on these back in 2010 and we found a
rate of 17% which was far too high . We found some hospitals
had a rate like at 40 % or 50% and another hospital would have
a 2% rate . So once I think hospitals saw for themselves the
variation and recognize d too many of these were happening,
they took it on , and so since 2010 that rate has gone way
down , it's plummeted . Today it's about 2.8% . It's something
that we knew we could address. We all knew it was a problem
and we made it transparent and now they're down. So we can
do same thing with maternal mortality, but we're going to all
have to work together and we're go ing to have to make this
public.

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Mark Masselli: You know, Leah, I want to pick up on your phrase there of
transparen cy. When I'm in New York City and I'm going to a
restaurant, I look at the sign outside. It's either an A, B or C. I
don't go into B or C . Why aren't we after our lawmakers to say ,
every hospital should post big letter outside that t his is an A, B,
or C, w hat can we do to get this grading system adopted if it's
good for us in terms of eating, my God, it's got to be much
more important if we're going into a hospital to know that
we've got a C rating and we have no idea?

Leah Binder: We actually designed our letter grade system, our Hospital
Safety Grade , exactly around the New York City restaurant
ratings. It was also done in LA , and in LA , they actually had a
couple of studies that showed that once they implemented
the letter grades for restaurants, they saw a reduction in
emergency visits for food borne illness. We're not trying to
legislate anything, but certainly what's important to us with
our letter grade is for the public to use it. By the way,
purchasers and health plans, anyone who's paying for large
amounts of healthcare, employees of a state or the employees
of the city are run by a government , they should be
demanding A s . People who go to a hospital, if they say, wait,
you don't have an A , w hy don't you have an A ? If they even
just ask the question, it can make a big difference.

Hopefully they do more than ask the question. They also say,
well doctor, I know you want to schedule me in that hospital,
but I'm not comfortable because they got a D and I'm just not
comfortable there. So is there somewhere else? This is
something where our lives are threatened. Hospitals need to
hear from the public , and the best way to remind them is the
old fashioned marketplace, the same marketplace that tells
restaurants if you get less than an A, I'm not going there. T he
way that states, cities, municipalities, all kinds of government
entities, purchase healthcare. They should be demanding this
in their contracting , t hat should be a critical element. No
hospital that gets a D should be on some Center of Excellence
list . So there's ways that I think we can all work on this and we
are beginning to see momentum and people doing exactly
that , really using this grade to send a message about the
importance of safety.

Margaret Flinter: We've been speaking today with Leah Binder , President and
CEO of the Leapfrog Group, an independent nonprofit
organization that's dedicated to improving safety and quality
in American Hospital Care. You can learn more about their
work and access their latest report by going to
www.leapfroggroup.org or follow them on Twitter

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@ LeapfrogGroup. Leah, we want to thank you for your
ongoing commitment to exposing causes of harm in healthcare
and for joining us on Conversations on Health Care today and
bringing this really important information to the American
public. Thank you so much.

Leah Binder: It was a pleasure , and thank you so much for raising awareness
about so many issues including this one.

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Mark Masselli: A t Conversations on Health Care , we wan t our audience to be
truly in the know when it comes to the facts about healthcare
reform and policy. Lori Robertson is an award winning
journalist and Managing Editor of FactCheck.org , a
n onpartisan, nonprofit consumer advocate for voters that aim
to redu ce the level of deception in U.S. Politics. Lori, what
have you got for us this week ?

Lori Robertson: A Twitter spat between President Donald Trump, his son Eric
and New York City Mayor Bill de Blasio touched on the public
health issue of crime. The Trump claimed crime has risen in
the city under de Blasio ’s leadership, but that's wrong
according to crime data kept by the New York Police
Department . Major felony offenses have dropped every year
de Blasio has served as the city's mayor according to NY P D
data . Other felonies are down, misdemeanors are down,
arrests are down. According to FBI crime data, New York City
had a lower violent crime rate than all but two other cities
with a population over 1 million in 2017 . Nonetheless, in a
Twitter spat with de Bla sio on May 14 Eric Trump claimed that
under de Blasio ’s leadership, “ Crime is up in New York City. ”
Two days later, de Blasio , a Democrat , announced his bid for
the presidency . That prompted President Trump to
sarcastically tweet that, “ If you like high ta xes and crime , he's
your man .” As a mayoral candidate in 2013 de Blasio vowed to
end the controversial stop and frisk policy, a get tough on
crime tactic of stopping people for suspicious activity that was
begun under Former Mayor Rudy Giuliani and expande d under
Former Mayor Michael Bloomberg. As it faced court
challenges, the policy was well on its way out by the time de
Blasio took office in early 2014 , but it was greatly reduced
during his tenure. Although many critics warned it would spur
a return to h igher crime rates , t hat didn't happen. Patrick
Sharkey, a sociology professor at New York University , told us,
“ Crime is definitely not up under de Blasio. ” Last year was the
lowest murder rate on record for the city , h e said . In 2017
New York City's viole nt crime rate was the lowest since at least

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1985 . And that's my fact check for this week , I'm Lori
Robertson, Managing Editor of F act C heck.org .

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Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's major political play ers and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you'd like checked, e - mail
us at www.chcradio.com , we'll have FactCheck.org's Lori
Robertson chec k it out for you here on Conversations on
Health Care.

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Margaret Flinter: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives.
According to the World Health Organization, some 35 m illion
people suffer from some form of dementia and 65 million
people are expected to develop dementia by the year 2030
and still no cure on the horizon. But studies show those
dementia patients who remain more active who stay outside
the clinical setting are more likely to have a much better
quality of life. And that's the basis for a first of its kind
dementia village in the Netherlands Hogewey an enclosed
village built to look and feel exactly like a normal village but
designed to house patients with adv anced dementia.

Yvonne van Amerongen : One of the things that are very important to people with
dementia is that they don't understand what's happening. We
try to help people understand what's happening and let them
feel that it's okay.

Margaret Flinter: Co - Founder Yvonne van Amerongen says , these patients have
lost their ability to process new surroundings and the enclosed
village provides a safe and pleasant environment for them to
live where they can walk, socialize, remain engaged. The
village was built with 23 connected housing units where a
patients ar e group based on their earlier personal lifestyles,
whether it was interested in the arts or music, academics,
gardening, and all living areas are manned 24x7 with trained
clinicians who help to maintain a sens e of normalcy as well as
safety.

Yvonne van Amerongen : Those people you live with should be people that –

Margaret Flinter: And the director says , relatively no need for excess
medications or restraints that are so commonly used in
dementia wards in s o many nursing homes around the globe.
In a way, some have compared it to the movie The Truman

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Show, but the village co - founder says it's necessary to
maintain a predictable routine . A planned and closed
residential community designed to maximize quality o f life for
dementia patients, creating a life with dignity for patients who
might ordinarily be institutionalized, sedated, or restrained ,
n ow that's a bright idea.

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Mark Masselli: You've been listening to Conversations on Health Care. I'm
Mark Mass elli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and health.

Conversations on Health Care is recorded at WESU at
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