In many cases, especially for elective procedures and surgeries, you may get to choose between several alternatives for hospital care. Making the best choice takes time and careful evaluation. Typically, an unsatisfactory selection of a hospital isn't realized until something goes wrong and it is too late to be changed. Therefore, to make the right choice, you should become as educated as possible by assembling as much useful information as you can. Try to gather information from many sources and in many forms - the more sources of information, the better - including:

• Your health benefits officer at work/fellow employees
• Friends/family
• National accreditation agencies
• Ratings of hospitals by Health Grades, Inc.

• Outcome measurements
• Staff ratios
• Treatment options
• Financial options
• Referral networks

Types of Hospitals

1. General versus Specialized

The majority of hospitals in the United States are "general" hospitals set up to accommodate the full range of medical conditions for which most people require treatment. But more than 1,000 hospitals specialize in a particular disease or condition (oncology, rehabilitation, psychiatric illness, etc.), or in one type of patient (children, etc.).

2. Teaching versus Community

Teaching hospitals, in addition to treating patients, train Doctors and other health professionals. They are almost always associated with a medical school, and therefore give patients access to the latest technologies and highly skilled specialists who teach at the medical school.

The quality of smaller, community hospitals, however, is often as good as it is at teaching hospitals, especially for routine procedures and treatments.

3. Nonprofit versus For-Profit

Nonprofit hospitals usually operate under religious or other voluntary organizations. For-profit or proprietary hospitals are commercial establishments owned by corporations or individuals such as doctors who practice at the hospital. Often hospital corporations own a chain of institutions in a geographic area, as well as nursing homes and other types of health care facilities.

Quality Measurements

When analyzing hospital quality, it is best to look at several quality measurements and make your decision based on many criteria. The following are some good quality measurements to include in your evaluation.

1. Hospital Ratings

Ratings that compare hospital performance are an important resource for health care consumers. Hospital ratings by HealthGrades risk-adjusts hospital data and provides up-to-date, objective, accurate quality ratings for hospitals across the U.S. in areas such as cardiac surgery, cardiology, orthopaedics, neurosciences, respiratory medicine, vascular surgery, and obstetrics.

2. Accreditation

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the nationwide authority that surveys hospitals. The JCAHO decides whether a hospital keeps or loses accreditation based on its meeting certain health and safety requirements. Although accreditation is voluntary, most hospitals go through the process. If the hospital you are considering is not accredited, it is important to know why.

3. Experience

For some common problems, almost all hospitals have sufficient experience. In the case of specialized medical and surgical care for a complex problem, however, the more experience the hospital has with the necessary procedures, the better the results will usually be. Ask how often the procedure that you may need has been performed at the hospital you are considering. Compare that with the experience of other hospitals.

4. Other

The hospital itself can often be a source for quality information concerning how well patients recover from surgeries or treatments in which you may be interested. Many hospitals' public relations or marketing departments will provide this information. Although all risks associated with certain procedures cannot be eliminated, they can be reduced by choosing a hospital with good outcomes for those treatments. For example, find out what the hospital's mortality and complication rates are for the procedure you might need. Ask about 5-year survival rates for certain illnesses such as cancer. Ask about quality of life that can be expected following treatments. Compare these outcomes with those from other hospitals. Other quality indicators you may want to ask about include the following:

a. R.N. Staff

The number of nurses on staff in a hospital, in relation to number of patients or other hospital staff, is often a measure of quality that directly affects patient care. According to the American Hospital Association, the national average is a little more than four R.N.s to every licensed practical nurse (L.P.N.) who is qualified to perform a limited range of duties.

How many R.N.s are there for each patient? One nurse can usually care for three to six patients, except in intensive care units where the ratio is more likely to be one R.N. for every one or two patients.

b. Infection Control Practitioner

Is there an infection control practitioner on staff at a hospital? If not, how does the hospital address this issue? About one in 20 American patients gets sick from their stay in the hospital. Hospital-acquired illnesses are a major concern, especially since one-third to one-half of acquired infections are preventable.

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Customer Satisfaction

1. Surveys

Many hospitals routinely use surveys to learn if patients are satisfied with their experiences. Hopefully, the hospital uses the results of these surveys to improve its services. Hospital surveys typically focus more on the personal side of care (good communication to patients, cleanliness, food quality, etc.). Hospitals that do not use patient surveys may not see the patient's perspective as important. Find out if a hospital keeps patient satisfaction surveys and if you can see the results. Even if the results are not shared, simply confirming that the hospital does utilize surveys for quality improvement may be positive sign.

2. Customer Service

Visit the hospital you are considering and look around. Is the facility clean? Do waiting rooms and patient care rooms look comfortable and well maintained? Is the staff courteous and helpful? Find out how patient complaints are handled by the hospital.

3. Personal Reference

Ask doctors and other health care professionals which hospital they would choose and why. Also seek recommendations from colleagues, friends, and family.

4. Employee Reference

If you can find someone who works at the hospital you are considering, ask them what they think of the department or clinic where you will receive care. The quality of different departments within a hospital can vary significantly. Insiders often know which departments are good and which need improvement. Insider information is frequently a fast, good way to estimate the quality of the care you will receive.

You might also call the department responsible for the procedure or treatment you may need, and ask them questions directly. The tone and attitude of the answers may reveal more about the hospital than the actual answers. Is the staff helpful and courteous, or hurried and impatient?

Access

1. General

Is the hospital conveniently located to your home and/or work? What are the visiting hours and are there any restrictions on visitors? Is the hospital near public transportation? Is affordable parking available? All these basic issues, often overlooked, should be considered in your evaluation.

2. Doctor/Health Plan Affiliation

Is your doctor and/or health plan affiliated with the hospital? Your doctor must be affiliated with the hospital you choose. Doctors are usually affiliated with several hospitals, meaning they have met those hospitals' requirements and are allowed to treat patients in those facilities.

Range of Services

1. Range of Departments

Medical conditions do not always exist in isolation. Related and/or unrelated complications may occur in the hospital and managing these problems requires a multidisciplinary team approach with doctors from several specialties. Therefore, immediate access to a full range of specialty departments within a facility may be important. Ask the hospital to list the full range of specialty department backup available in the hospital if complications arise. Compare this list with other hospitals

2. Range of Diagnostic and Treatment Options

There may be more than one way to treat your medical condition. If your Doctor can diagnose and treat your condition in several ways, the hospital should be equipped for all these possible treatment options. Ask your Doctor to list the full range of options for diagnosing and treating your condition and compare this to hospital options.

3. Referral Network

How extensive is the hospital's referral network? If a hospital does not have the staff and/or services necessary to treat a complication or problem that occurs while you are admitted in the hospital, it will have to transfer you to another facility. Find out what arrangements a hospital has with other hospitals.

4. Financial Options

Hospital charges vary. If you are likely to pay a percentage of the charges before your insurance coverage begins, you should know what your costs will be. What is the charge for a bed in a semiprivate room? Are private rooms available? How much is charged for a private room? What do these charges include? What is billed separately? If the hospital's charges exceed what your insurance company considers "reasonable and customary," can some compromise be reached on the price? Is there a hospital payment counselor to help arrange payment installment plans for charges you will be paying out of pocket? Does the hospital provide any resources to help you find financial assistance if you need it?

Financial issues can be very confusing. Review them carefully with your benefits manager, review your policy, and speak with someone in the hospital business office to make sure you have your facts straight.

Checklist/Questions to Ask When Choosing a Hospital

• Check the hospital ratings by HealthGrades for the procedure you may need, or for any related procedure or diagnoses.
  
• What is the hospital's JCAHO accreditation status?
  
• Is your doctor affiliated with the hospital?
  
• Does the hospital accept your insurance?
  
• Find out how often the procedure you may need has been performed at the hospital.
  
• Get any outcome measurements (mortality rates, complication rates, 5-year survival rates, quality of life measurements, etc.) related to the procedure you may need from the hospital.
  
• How many nurses are on staff at the hospital?
  
• What is the R.N.-to-patient ratio at the hospital?
  
• Is there an infection control practitioner on staff at the hospital?
  
• Does the hospital use patient surveys? Can you see the results?
  
• Call and visit the hospital. Is the staff courteous and helpful?
  
• Is the hospital clean? Do waiting rooms and patient rooms look comfortable?
  
• How are patient complaints handled by the hospital?
  
• Ask your doctor and other healthcare professionals which hospital they would choose and why?
  
• Ask friends and colleagues what hospital they would recommend and why?
  
• Is the hospital conveniently located?
  
• Find out the full range of specialty department backup available in the hospital if complications were to occur related to the surgery or treatment you may need (for example, neonatal intensive care unit, trauma center, etc.).
  
• Ask your doctor to list the full range of options for diagnosing and treating your condition and compare this with other facilities.
  
• Does the hospital have an extensive referral network? Find out what arrangements the hospital has with other facilities.
  
• Carefully evaluate all financial charges between hospitals. Talk carefully with your benefits manager, review your policy, and speak with someone in the hospital benefits office to make sure you have all financial facts straight.

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