How to Become a Top 100 Hospital

It Can Be Done

When I started my first quality program, my teams and I only focused on one thing—improving care for our patients—and rightly so. Today, that is still my number one goal for every program I help build.

Along the way, we started earning quality awards, which I can honestly say wasn’t a top priority. But as more awards came into the organization, I started to see some interesting effects. Our employees were showing more pride in working for our organization. Improvements occurred with increasing frequency and physicians and nurses were asking to start new improvement teams. They had never done that before.

Benefits of Earning Quality Awards

Then I noticed two other benefits receiving awards had on our organization. First, they provided external validation that we were doing a great job of caring for our patients. Like all of us in healthcare, we are often our own worst critics so the awards showed us we needn’t be so critical. Second, each new award gave us a reason to celebrate. We could say to every employee, “Wow, we’re one of the top hospitals in the country for bypass surgery,” or “We’re in the top hospitals for caring for patients with pneumonia.” Earning each one was a positive event for our organization.

When We Received a 1 Star Rating We Deserved It!

Now I’ll be the first to admit that these awards can create some controversy. Since each rating agency uses different measures, has different methods for calculating quality, and some don’t disclose their risk adjustment models, there are those who question the validity of the findings. So for good measure, one year we compared our internal data to the assessments provided by two of the rating agencies. We could not find many differences between their results and ours despite the different methodologies that were used. We also learned that when we received a one-star rating, we deserved it. And when we received five stars, we deserved that rating as well.

What Truven Measures for the 100 Top Hospital Award

After our first 100 Top Hospitals award, we took a closer look at the measures the different rating agencies used, since they represented all the things we should excel at anyway. The first, Truven Health Analytics, reported performance on core measures, complications, mortality, readmissions, length of stay (LOS), patient satisfaction, and financial performance. We made sure these measures were in our dashboards and improvement goals, and thankfully, most were already there.

What Healthgrades Measures

The second agency, Healthgrades, reports mortality and complication rates for high-volume surgical procedures and medical conditions. Nothing wrong with that approach and, in fact, it was completely in line with our clinical improvement program. We had improvement teams for all of our high-volume, high-cost surgical procedures and medical conditions. And our goal was to reduce complication rates while improving mortality, LOS, and readmission rates. In the end, we discovered that we were in complete alignment with both of these rating agencies.

Even Playing to the Test Creates Better Quality & Safer Care

Did we start “playing to the test?” I guess you could say we already were; we just didn’t know it. With just one program, we were already targeting high-volume procedures and medical conditions and both rating agency’s other metrics.

Since then, I’ve helped more than a handful of hospitals hit the 100 Top Hospitals list and the 15 Top Health System list. The question is this: Is it possible for the average community hospital to be a top-ranked hospital. Absolutely!

Does Size Matter?

Does size matter? Nope. In fact, many average-sized community hospitals have become one of the 100 Top Hospitals in the country. One of our 60-bed hospitals hit the list three years in a row. And many larger hospitals are on the list too. Size doesn’t matter; location doesn’t matter. I’ve even seen hospitals that were in grave turn-around situations make it on the list after instituting a robust quality and safety program. What matters is the belief that it can be done, that you can make it happen, and then build on this belief with a solid plan, infrastructure, and the persistence to pursue your goal!

The Road to the Top 100

One year, Tom Atchison was the speaker at one of our strategic planning retreats. He’s a national thought leader on healthcare leadership and a great facilitator. We were talking about our goals for several years into the future and he was getting frustrated with our lack of commitment and aggressiveness. We just weren’t pushing ourselves to step out of the box and put a stake in the ground—a stake that would make a difference to our patients, our community, and us.

First, the BHAG

He challenged us to come up with a big, hairy, audacious goal, a BHAG, a goal that would set us apart from all the other healthcare systems in the country. And he demanded that we drop the usual milk-toast statements that you see in run-of-the-mill mission and vision statements. It was a wake-up call to everyone in the room.

After a break we did as he suggested and created several audacious goals. We called it, for the sake of illustration, Vision 2020. We had two quality goals that were clear and concise. First, we were going to have “The Best Clinical Outcomes in the Nation.” And second, we were going to “Create the Safest Health System in the Nation.” They were easy to remember, simple to understand, and easy to translate for everyone in our organization and our community.

The Rallying Cry

These two statements became our rallying cry for the next five years. You’re thinking to yourself—are these two goals realistic? Can my organization do this? Can we become “a” or “the” leading hospital or health system in the country? I’d say, why not? Remember, anything is possible when we set our minds to it. When you have a plan and an entire organization is aligned behind a big, hairy, audacious goal—why not? Sure it takes commitment, resources, and a stick-to-it attitude. But it can be done.

I’ve seen many ordinary organizations start just like this. They developed a BHAG, had dedicated leaders, and a commitment to provide the needed resources, and five years later, they’re listed in the top of the national ratings. Here’s what happened at the organization I mentioned above (we received all of these ratings for many years):

  • Top 5 percent of United States hospitals for clinical quality
  • 100 Top Hospital® list–several of our system’s hospitals and many more in the top 10 percent
  • 50 Top Cardiovascular Hospitals
  • 10/15 Top Health Systems[1]
  • One year we were the Top Health System in the nation[2]
  • In ten years our system and hospitals received over one hundred quality awards

You Can Do It!

Were we surprised? Honestly, yes. I remember our CEO walking into my office shortly after we learned we were listed in the 10 Top Health Systems in the country. He had one question for me, “Will we be able to stay on the list?” My honest answer was, “Boss, I really don’t know, but we’re going to give it one heck of an effort.” I knew we had a good plan; it had all the right ingredients to get us to our goal. We “began with the end in mind,” which was to improve care for as many patients as possible. When we did that, the awards just came. There’s no reason it can’t also work for you. So what does it take to be a Top Hospital or Health System in America today? Here’s a short list:

  1. Adequate resources – personnel trained in quality and safety science. 1 FTE for every 100 beds or part thereof.
  2. The right data – clinical dashboards for your top 30 high-volume, high-cost, high risk surgical procedures and medical conditions. You can only manage what you measure. So if you want to improve care for the majority of your patients, you need to measure the quality of care for the majority of your patients.
  3. Organized physician leadership that’s focused on outcome improvement as their number 1 job.
  4. Physician and nursing leaders working side by side to improve care together. It’s a team sport.
  5. A C-Suite that helps lead the charge and a CEO who does lead the charge.
  6. Believe you can do it! Celebrate your wins! Never stop improving!

John Byrnes MD is author of The Quality Playbook and Executive Director of HRO Academy™. He publishes advice on quality and safety on his blog at


[1] Formerly the Thomson Reuters 10 Top Health Systems, now Truven Health Analytics 15 Top Health Systems.

[2] Based on review of rankings provided by the rating firm