The Big Story: 9 takeaways from 3,700+ ranked hospitals
“The four major rankings almost never pick the same hospital. Of the 5,432 hospitals assessed, just three were included among U.S. News‘ Best Regional Hospitals, Forbes and CMS’ five-star hospitals and Lown’s honor roll.”
Purpose, measurement and the purpose of measurement
By David Jarrard and Tim Stewart
3-minute read
Surely, after a century of modern medicine and armies of statisticians equipped with more dashboards that anyone can count, we know.
Or, maybe, not.
Becker’s recently compared five prominent 2026 hospital rating systems: US News, CMS, Forbes, Lown and Leapfrog. More than 3,700 hospitals – 85% of US acute-care facilities – received a score from at least one of them.
And they mostly disagree.
Only three hospitals were recognized as among “the best” across the four major lists. The two lists with the most overlap agreed on only 23% of the same hospitals.
Apparently, we know excellence when we see it. We just don’t agree on what we’re looking for.
The rankings aren’t necessarily in conflict; they’re answering different questions about what “good” entails.
They are keeping scores for different games.
The disagreement tells us less about the quality of the measurements than about the enormity and complexity of the answer the ratings strive to reflect.
It’s a reminder to be mindful of what you choose to measure. The metrics you value shape your entire organization and the very care you provide.
After all, we chase numbers to accomplish something far beyond them.
The “good” hospital
The rankings reflect good faith efforts to measure what good healthcare is. CMS emphasizes outcomes. Leapfrog emphasizes safety. Lown gives substantial weight to equity. U.S. News considers outcomes across specialties. Forbes weighs best practices, value and patient experience.
But can a hospital score well on a battery of metrics but not be a good hospital? Could it be that, in the end, what makes healthcare truly good cannot be measured with a yardstick?
You know the answer.
Still, measurements certainly matter. A lot. Infection rates. Patient volumes. Reimbursement rates. Market share. There seems to be an endless dashboard of mission-critical gauges to monitor.
Aristotle tells us that every human pursuit aims toward some good – its telos, the end or purpose toward which it is directed. What is a thing for, and does it fulfill that purpose well?
The challenge with all these measurements is when they become a replacement for purpose. Is your highest priority delivering outcomes because you know your community and your providers and have determined that’s the right north star for your hospital? Or is it because you really want to slap that U.S. News logo on a billboard?
What is your hospital for?
What’s Your Score?
Philosopher C. Thi Nguyen in his bestseller The Score has a name for what can happen when measurements and ratings eclipse the purpose for an organization: value capture.
When we care about something complicated – providing excellent care, for example – we design simpler proxies to monitor our progress. We create a score.
Useful and necessary, until “Are we providing excellent care?” morphs into the far easier question “Did we get five stars?”
The danger, says Nguyen, is that “metrics are usually formulated in terms that squash whatever is really important to us.” Without wise handling and constant attention, metrics can “drain the life out of what really matters.”
To be clear: The danger isn’t measurement. It’s allowing the metric to redefine what matters. We’ve become “captured” by our metrics. Our goals become our purpose.
Did you mention Drucker?
Wait. Did you just mumble “what about” management guru Peter Drucker and his line “What gets measured gets managed”? Or were you thinking of W. Edward Deming’s “If you can’t measure it, you can’t manage it”?
Here’s a fact check: Neither of these business Yodas actually uttered those words. A “costly myth,” said Deming, who disagreed with the notion. And Drucker? He taught that doing the right things – being effective toward your purpose – was far more important than doing things efficiently.
Think instead of the Goodhart’s Law – from economist Charles Goodhart: “When a measure becomes a target, it ceases to be a good measure.”
Measuring Matters
Of course it does.
Physicians measure relentlessly, thank God. White blood cells. Hemoglobin. Creatinine. Blood pressure. Oxygen saturation. All part of the concoction of good clinical care.
But while a healthy white blood cell may be the goal of treatment, it’s not the purpose of medicine. Serving the patient well is.
Managing the health of a hospital requires the same wisdom. Margins matter. Mortality matters. Engagement matters. Experience matters. Safety matters. Measure them all.
And yet: None of these are the purpose of your healthcare organization. Don’t be captured by them. Instead, seat them appropriately in service to something more.
What is a good hospital for? You can’t answer that question with a list, a rank or a constellation of stars. Not really.
It is the difficult, heart-checking question leaders and boards must keep asking, especially today as our industry struggles to be trusted by the very people our organizations are built to serve.
By all means, pursue your organization’s place on your preferred rating list. Just remember that even the highest score is a signpost point to your true destination.
Measure what matters. But never let what you can measure decide what matters.
