The Lown Institute Hospitals Index: A Field Guide for a New Health System.

• Author: Saini, Vikas

What makes for a good hospital? Good treatment, of course, is a bedrock. No matter who we are, we all want to get better when we are seriously ill. But do medical responsibilities begin and end with the act of caring for patients? That idea never sat well with Dr. Bernard Lown, the founder of our organization.

Lown was the co-inventor of the modern cardiac defibrillator, a pioneer of coronary care units, a world authority on sudden cardiac death, and a consummate clinician. He was also a champion of the idea that the medical community has a duty to address the health of the wider society. In the 1960s and '70s, when Lown was a Harvard University professor at the height of his career, there was no greater threat to communal health than nuclear proliferation. This belief drove him to cofound International Physicians for the Prevention of Nuclear War, which was instrumental in opening a dialog between the Soviet Union and the West, and which won the Nobel Peace Prize in 1985.

Lown's expansive vision of the role of medicine has very much informed the Lown Institute Hospitals Index. American hospitals are justifiably admired for their innovative technology and highly skilled physicians and nurses. Their acute care is second to none. But the health of our nation lags behind every other wealthy country on the planet. One reason is a highly commercialized health care system that forces hospitals to chase revenue to stay afloat--or, as hospital CEOs sometimes say, "No margin, no mission." That means a focus on filling beds, attracting patients with well-paying (read: private) insurance, and prioritizing high-margin procedures. Uneven quality of care among different hospitals, varying rates of unnecessary tests and treatments, and very different profiles in social responsibility are the natural result.

Existing hospital rankings have examined only one of these aspects of hospital performance--quality--and those rankings have changed hospitals' aspirations. But we believe that hospitals can and want to avoid unnecessary treatments too. They also want look beyond their four walls to engage more directly with the needs of their communities. What's been lacking is a context that both expects them to move in that direction and provides them with clear guidance on how to do it. The Lown Institute Hospitals Index put its shoulder to that wheel.

To build our index, we talked to a wide variety of policy experts, physicians, nurses, patient activists...