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How Well Can We Identify the High-Performing Hospital?

The Issue

Being able to accurately identify high-performing hospitals is important not only for benchmarking and learning purposes, but for designing pay-for-performance programs as well. Most studies of high-performing hospitals routinely use only one or two performance measures, or a composite measure. In this examination of hospitals achieving high scores on composite measures, researchers delved into the measures to see how hospitals performed on each of the individual component measures and on survey-based measures of patient care quality.

What the Study Found

Hospitals that rank highly on a composite measure do not necessarily score high on the individual components. Very few hospitals in the sample were top performers on most measures, and the number of high-performing hospitals was "not much larger than expected due to chance." The study also found that survey-based measures of performance may be more valid than commonly believed. Survey-based assessments of patient care quality by clinicians and quality managers can be useful complements to patient satisfaction measures, the authors suggest.


Policymakers and health insurers should consider using both component measures and a composite measure in designing pay-for-performance programs to ensure they reward hospitals fairly for performance.

Publication Details

Publication Date: August 24, 2011
Author: Michael Shwartz, Ph.D., Alan B. Cohen, Sc.D., Joseph D. Restuccia, Dr.P.H., Z. Justin Ren, Ph.D., Alan Labonte, D.B.A., Carol Theokary, D.B.A., Raymond Kang, M.A., and Jedediah Horwitt, M.P.H.
Summary Writer: Deborah Lorber
Citation: M. Shwartz, A. B. Cohen, J. D. Restuccia et al., "How Well Can We Identify the High-Performing Hospital?" Medical Care Research and Review, June 2011 68(3):290–310.