Remember when a hospital was just a hospital, and its reputation spoke for itself? Now we have a plethora of self named healthcare institutions such as clinics, community hospitals, institutes, medical centers, national hospitals, specialty hospitals, and teaching hospitals.
My home state of New Jersey, for example, started with one children’s hospital in Newark, followed by a few more designated under state Health Department competitive certificate-of-need guidelines, followed by a few politically designated by the Legislature, followed by a bunch of sound-alikes such as a “children’s medical center” mischievously bypassing the fact that “children’s hospital” is a legislatively restricted name.
For the most part these appellations are used to define the hospital to its community and publicly compare it most positively to other nearby competitors. However, more and more hospitals are now calling themselves regional medical centers and university hospitals. These are very robust terms, sometimes used interchangeably or together, and imply characteristics such as comprehensive critical-care services, cardiac surgery/interventional cardiology, comprehensive stroke care, an academic environment, the latest cutting-edge technology, and a full-time cadre of 24/7 on-site superspecialist physicians, including intensivists.
And the not-so-subliminal message is that when you are very sick or injured you should bypass your local hospital.
The reality is that in New Jersey a hospital can call itself whatever it wants—there is no name regulation or oversight by state authorities. A few years ago Robert Wood Johnson University Hospital challenged and lost, when St. Peter’s Hospital added “University” to its name. Since then a number of other hospitals have added “University” as well, and more will follow. Certainly this phenomenon is not limited to New Jersey.
The Association of American Medical Colleges states: “Teaching hospitals are providers of primary care and routine patient services, as well as centers for experimental, innovative and technically sophisticated services. Many of the advances started in the research laboratories of medical schools are incorporated into patient care through clinical research programs at teaching hospitals.”
I believe a university hospital/regional medical center should have most of the following characteristics typical to “major league” hospitals:
■ First and foremost, it should have a written affiliation agreement with a medical school that includes the rotation of medical students to the hospital for required third year clinical rotations in internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery.
■ The hospital should have full-time chairmen in the core clinical departments (e.g., medicine, pediatrics, surgery) selected by a joint hospital-medical school search committee, and not as a reward for seniority or admitting a lot of patients.
■There should be at least three physician residency-training programs under the supervision of the medical school.
■ All physicians teaching students and residents should qualify for faculty appointments at the affiliated medical school.
■ A dean’s committee composed of senior medical and administrative staff from the hospital and school should meet regularly to jointly set strategic priorities and evaluate program efficacy and performance.
■ The hospital’s medical staff bylaws should mandate automatic removal from the staff of any physician who does not achieve board certification after a given period of time, such as five years.
■ The hospital should have at least three state-designated critical-care services such as trauma center, regional perinatal center (high-risk obstetrics), stroke center, children’s hospital or cardiac surgery. There should be full-time intensivists in all ICUs.
■The hospital should be a member of all major statewide multihospital clinical-care quality projects such as the New Jersey Hospital Association’s ICU and pressure-ulcer collaboratives. It should participate in clinical trials that the medical school has undertaken, and be a training site for students in nursing, pharmacy, physical therapy and other health professions.
■It should have a full-time chief medical officer, a senior physician preferably with a master’s degree earned through the American College of Physician Executives (or equivalent) and a chief nursing officer with an appropriate doctoral degree.
■Finally, the hospital’s board, administration and medical staff must have a demonstrable unwavering “safety net” commitment to the medically underserved.
These steps are, of course, easier said than done, so here are some initial steps for the states to consider:
State hospital associations should set up task forces to develop a policy and strategy to make sure hospital names are educational to the public, not exaggerations of capability.
A state could pass a law or the health department could promulgate regulations defining the requirements to be designated a university hospital or regional medical center. These designations should be subject to periodic state review.
Obtaining the appropriate and best hospital care should not be complicated by creative and clever hospital marketing but by easily understandable evidenced-based standards and metrics—and names.
* By Jonathan M. Metsch, Dr.P.H., August 18, 2008 • Modern Healthcare