Week 13: Strengths and Drawbacks of Hospital Ratings Capstone Project


Write a capstone project on the strengths and drawbacks of hospital ratings

Exploring the Strengths and Drawbacks of Hospital Ratings


Evaluating the quality and safety of care provided in healthcare facilities is increasingly important for patients, providers, and insurance payers, as shown by increased public reporting of data related to healthcare quality and safety, as well as reimbursement modification that prioritizes value over volume (Austin et al., 2015). As a result, the marketplace has witnessed an increased consumer-inclined hospital rating systems that evaluate and compare various healthcare facilities in terms of quality and safety. As a healthcare administrator, it is especially important to be familiar with the strengths and weaknesses of different forms of hospital ratings, such as patient safety measures, outcome measures or clinical quality, and patient experience measures. Being equipped with the standardized rating system healthcare organisations apply is vital in fixing the objectivity of the outcome.


Hospital rating systems continue to trigger conflicting views regarding their ability to represent the specific quality of care in different organizations. While some stakeholders find them effective in highlighting an organization’s strengths and weaknesses, others establish that the lack of clear assessment standards confuses them (Hu & Nerenz, 2017). As a result, some proponents of the ratings indicate that enhanced transparency can optimize the benefits of hospital ratings to patients as well as practitioners. On the other hand, the opponents call for new ways of evaluating the quality of care in each organization (Holiday et al., 2017). Currently, the common rating systems include that of the Centers for Medicare and Medicaid Services (CMS) and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The CMS has a 5-star rating framework that examines how providers promote high-quality and safe services (Wang et al., 2016). The key components include the nature of patient-practitioner communication, mortality rates, readmission, family involvement in decision-making processes, staff responsiveness, and commitment to safety promotion, among others. The rating systems also examine the quietness of care environments, hygiene, and overall care quality (Bilimoria et al., 2019). Healthcare leaders can maximize the benefits of rating systems by involving all stakeholder groups in planning processes to standardize the assessments while promoting coordination.

Problem Statement

Even though the marketplace is currently increasing with hospital rating systems, comparatively few details are known regarding what the ratings reveal and whether they are reliable. Currently available data regarding the relationship between hospital ratings and other health measures shows mixed results. For example, DeAngelis (2016) shows that being listed in the US News and World Reports as one of the leading hospitals is linked to reduced thirty-day mortality. Yet other studies have reported no significant associations between being listed in the US News and the rate of readmissions, widespread discrepancies on several indicators, and variations with other standardized rating systems included in the CMS’s Hospital Compare (Austin et al., 2015). Hospital rating systems use diverse methods to differentiate “high” performing from “low” performing healthcare facilities, which later creates an inconsistency of hospitals concurrently perceived as best or worst based on the rating system used. For instance, Hwang et al. (2016) note that 43% of healthcare organizations categorized as having below-average death rates based on one risk-adjustment strategy were categorized as having above-average death rates by an alternative method.

The contradictions in the hospital rating systems are sources of confusion for various stakeholders that rely on the information. Adelman (2020) ascertains that effective rating systems should not only comprise precise measures but also represent the views of patients, providers, and payers, among other stakeholder groups. The contradictions in hospital ratings make it complex for consumers to determine the actual hospital quality. For payers, the differences make it challenging to identify and reward hospitals for high quality. For hospital leaders, including healthcare administrators, the conflicting rating systems obscure decisions regarding where to focus on improving. To better comprehend the differences in the hospital rating systems and their implications on hospital stakeholders, the paper will review the weaknesses and strengths of hospital rating systems, the strategies underlying the ratings, and whether the methodologies offer a convergent or divergent depiction of high and low-performing healthcare facilities. The primary research question for the project is whether the hospital rating systems are reliable and objective. Supporting research questions include:

  • How different are the various forms of hospital ratings?
  • What are the inherent weaknesses and strengths of hospital ratings?
  • Do the available ratings offer a uniform picture of high and low-performing hospitals?
  • Which hospital rating system is the best?

Literature Review

An Overview of Hospital Rating Policies

The Primary objective of hospital rating and ranking practices is to optimize the overall quality of care. The existing regulations emphasize the delivery of care services that promote patient-centeredness. DeAngelis (2016) discovers that the ratings reflect how hospitals commit to quality improvement efforts. The author indicates that organizations listed as industry leaders tend to exhibit minimal 30-day mortality rates. For example, the Centers for Medicare and Medicaid Services (CMS) uses a 5-star rating system to evaluate the quality of patients’ experiences across different hospitals. According to policymakers, the program will promote transparency and treatment outcomes in line with the Affordable Care Act. Smith, Yount & Sorra (2017) affirm that appropriate safety cultures contribute greatly to desirable rating outcomes. Based on the results, managers’ efforts towards allocating adequate resources to safety promotion programs directly affect the ratings. Therefore, they imply that the current rating systems are reliable.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) calculates hospital rates based on various indicators, communication systems, staff responsiveness, discharge information, and efficiency in care transition (Sondheim et al., 2021). Other items include the cleanliness of hospital environments, quietness, recommendations, and overall quality of care (Fontana et al., 2019). The above indicators are vital in determining the quality of care in a healthcare organization. However, professionals discover that the system has been confusing due to the lack of standard and precise assessment forms.

Common Challenges in Hospital Rating and Ranking

A thorough understanding of the specific problems associated with the current hospital rating systems is essential for formulating well-informed interventions. Most healthcare professionals discover that the assessment processes lack adequate levels of accountability and transparency (Chung et al., 2019). Despite emphasising the two values, the CMS has yet to integrate them fully into daily practice. Other practitioners state that the ratings do not necessarily reflect the ability of hospitals to reduce mortality and readmission rates. Austin et al. (2015) highlight major discrepancies between the quality of care and hospital ratings. The processes of rating care quality in different avenues differ significantly. For example, the CMS does not have similar standards as Hospital Compare. Therefore, practitioners and hospital leaders find it challenging to understand the most reliable approaches.

The lack of reliable rating standards confuses professionals and patients seeking the best quality of services. Hwang et al. (2016) compared findings from the rating systems and an alternative investigation. The first results revealed that over 40% of the selected hospitals ranked in the below-average category by death rates. However, the alternative study indicated that the same organizations ranked above average based on the same measure. The study suggests that well-coordinated measures are necessary to implement reliable rating standards. According to Holiday et al. (2017), healthcare stakeholders are yet to offer meaningful feedback concerning the rating systems. The main challenge is that they are yet to access adequate details regarding the initiative. Different groups, including patients and practitioners, have encountered diverse measures. Therefore, it is difficult to evaluate the entire system based on the views of different individuals.

Bilimoria et al. (2019) discover that current ratings offer conflicting results, making it difficult to identify top-performing healthcare organizations. According to the authors, the lack of objective rating standards confuses the stakeholders, especially patients who seek hospitals that offer optimal outcomes. Therefore, more defined policies and guidelines are necessary to generate the anticipated improvements in patient outcomes.

The Impacts of Hospital Rating on Care Quality

Comparisons between hospital ratings and patient outcomes are reliable for evaluating the systems. Unfortunately, several studies reveal major variations in the two variables. The authors report contradicting results in the investigations. Wang et al (2016) discovered that the CMS’ 5-star rating stating offers data that does not match trends in patient outcomes. For example, the CMS system ranks various organizations as the best in reducing 30-day mortality rates. However, independent assessments indicate that the hospitals have major deficiencies in delivering patient-centred care. The results reveal that it is difficult to use the ratings as a standard care quality measure at regional and national levels.

DeLancey et al. (2017) examined the link between hospital characteristics, their reports on care quality, and the CMS star rating framework. According to the findings, hospitals that receive the best CMS ratings are mainly large organizations with huge disparity gaps. Therefore, smaller organizations hardly obtain adequate consideration during the assessment processes. Healthcare professionals’ experiences also reveal discrepancies between ratings and the actual situation in some hospitals. Hu & Nerenz (2017) conducted a study among 150 cities in the United States. The results indicated that many practitioners experienced stress due to the lack of well-functioning and adequate hospital resources. However, their organizations received top ratings. In this case, the data suggest that current processes do not consider all the key determinants of care quality.

Best Practices for Developing and Implementing Rating Policies

Better rating standards are necessary to enhance the reliability of current practices. Glance et al. (2020) recommends “Shrinkage targets” to address challenges in the CMS rating system. The author ascertains that the approach can enhance inclusiveness such that even small-sized organizations can receive fair assessments. The suggested method ensures that different types of organizations have adequate representation in the policy development processes. The intervention is crucial since the current ratings only appear to reflect situations in large organizations. Therefore, smaller hospitals might lack recognition despite offering better qualities of patient experiences.

Wallenburg, Quartz, & Bal (2019) discovers that poor rating standards hurt hospital leadership. The authors feel that leaders experience difficulties communicating key measures and quality improvement guidelines to practitioners. Therefore, they suggest the alignment of institutional operations with the indicators to offer a clear overview of care quality. The consideration of the specific services that an organization offers is essential (Wang, Wadhera, & Bhatt, 2018). Patients and other stakeholders need to understand the specific areas in which an organization performs best through precise rating measures. Further research is necessary to gather further details on the rating challenges and measures for improving efficiency.


The study will adopt a qualitative research method to determine whether hospital rating systems are reliable and objective. The design provokes the “why,” “where,” “how,” and “when” questions. Lim & Ting (2017) define the qualitative research method as a form of research methodology that collects and analyzes non-numerical data to understand opinions, experiences, and concepts. The choice of this research design is based on the value that qualitative research methods have in painting a picture of the researched phenomenon. The researcher will solicit the opinion of colleagues to establish the content, criterion, and construct validity of the research instrument. Reliability will be tested by assessing the internal consistency of the items in the research instrument.

Data Collection

The study targets hospital employees working at the management level. Hospital rating systems are based on performance parameters that are primarily controlled at the managerial level. This group of respondents is chosen since employees in managerial positions within the hospital are responsible for making decisions that affect the line of quality in hospitals. Since the hospital rating system is a quality-oriented performance measure, the results directly affect hospital management.

Six participants with different standardised ratings were selected from each of the five local hospitals, A, B, C, D, and E. Data will be recorded for each of the 5 samples and analyzed to reveal sample dynamics. The study will utilize questionnaires as the primary survey instrument for collecting data. Questionnaires were developed by the researcher based on the objectives of the study. The questionnaire is organized into items that capture the perceived value of hospital rating systems and perceived objectivity as a measure of hospital productivity. The questionnaires will also record the participants’ level of job satisfaction.

The survey instrument will be distributed to targeted respondents through the researchers’ email. Respondents will be asked to identify their work and proceed to fill out the questionnaire. It is anticipated that it will take less than 5 minutes to complete the questionnaire. The data collected from the survey will be cleaned and organized.

This study will be conducted within the confines of ethical principles governing human research. A digital consent form will be developed and sent to each prospective respondent outlining the purpose of the research and guaranteeing the confidentiality of the information collected. Personality-identifiable data will not be used during the presentation of the results.

Data Analysis and Findings

Data Analysis

Data collected from the structured interview survey was recorded in a spreadsheet and analyzed. Population dynamics were assessed to include mean and median age, gender distribution, and length of practice among the practitioners. The participants’ roles in the healthcare organization were recorded alongside their respective healthcare organizations’ quality-oriented performance ratings. Their perception regarding the quality of care that the hospital offers to patients was recorded on an ordinal scale in which satisfactory care was given a 100% score; good was offered a 75% score, 50% for moderate, and 25% for poor services. Their rationale for the score they offer for their organizations will also be recorded as well as their overall job satisfaction. An ordinal scale will be used to assess the participant’s level of satisfaction with terms of service in the hospitals, whereby a 100% score will be used to indicate a very satisfied employee, 75% for somewhat satisfied, 50% for neutral, and 25% for dissatisfied workers. The hospital employees’ perceptions regarding the quality of care offered by their organizations will be analyzed and compared with the existing standardized hospital rating. A regression analysis will also be conducted to establish the relationship between job satisfaction and hospital rating.


After primary data analysis, it was found that the employees’ perceptions regarding the quality of care offered at their respective hospitals concurred with the existing standardized organizational ratings. Based on the information submitted by the participants, an average employee rating for hospital A was 50%, 62.5% for hospital B, 42% for hospital C, 57.5% for hospital D, and 52.25% for hospital E. The standard deviation of the established employee rating from the existing standardized hospital ratings was 0.0982, indicating an insignificant error. Therefore, the employees’ perceptions regarding the quality of care offered by the hospital generally agreed with the existing standardized ratings for each organization. A positive relationship between employees’ job satisfaction and hospital rating was also confirmed in the study. Hospitals where employees reported higher relevels of satisfaction had higher ratings than those with lower levels of employee satisfaction. As such, the findings qualify the assertion by Fatima, Malik & Shabbir (2018). that a hospital’s capacity to provide high-quality services to patients is regulated by its management strategy. A hospital that adopts management strategies in which employees feel appreciated report higher ratings as their workforce develop high levels of motivation to provide patient-centred care (De Simone, Planta & Cicotto, 2018). Therefore, hospital rating was dependent on employees’ levels of job satisfaction.

The findings confirmed the research hypothesis that the available ratings offer a uniform picture of high and low-performing hospitals. The hospital ratings established in the study based on insight presented by the participants concurred with the existing ratings for each of the five hospitals. Such findings reveal the effectiveness of standardized hospital ratings in describing the quality of care offered by each hospital. According to Lee, Gowen III & McFadden (2018), hospital ratings summarize a healthcare organization’s determination to promote patient satisfaction, consumer perception, patient engagement, and care improvement. They also indicate the effectiveness of organizational structure and management plan of action adopted by a hospital (Belasen, Belasen, Oppenlander & Hertelendy, 2020). The study also confirmed that hospital ratings could be used to estimate the level of job satisfaction among employees. According to Karem, Mahmood, Jameel & Ahmad (2019), employee satisfaction constitutes a key factor for a good hospital rating as it affects the quality of care patients receive. Therefore, findings from the study confirmed the speculation of the research.


Standardized hospital rating methodologies are necessary for properly coordinating quality improvement efforts across the healthcare sector. All the stakeholders need adequate information concerning the procedures, measures, and criteria used to rate care services in different hospitals. While all organizations have the primary objective of generating the best patient outcomes, it would be inappropriate to disregard variations in sizes and available care models. Based on findings from the literature review, some scholars support the current rating systems, while others find them confusing. Therefore, policymakers and leaders in healthcare organizations need to acknowledge both positions. As a result, it will be possible to uphold the outlined strengths and seek effective ways of mitigating the shortcomings. Research-based interventions will be crucial in the formulation of corrective measures. Therefore, patients, providers, and payers can contribute positively to the reforms by suggesting key barriers to the reliability of current rating systems. The continuous evaluation of new policies at regular intervals would ensure that they align with the anticipated improvements. Eventually, it will be possible to improve patient outcomes by offering credible hospital rankings.


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Belasen, A. T., Belasen, A. R., Oppenlander, J., & Hertelendy, A. (2020). Factors Affecting Patients’ Perceptions of Quality, Hospital Ratings, and some Thoughts about Post-COVID-19 Challenges. Hospital Ratings, and some Thoughts about Post-COVID-19 Challenges (June 18, 2020)https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3629972

Karem, M. A., Mahmood, Y. N., Jameel, A. S., & Ahmad, A. R. (2019). The effect of job satisfaction and organizational commitment on nurses’ performance. Journal of Humanities and Social Sciences Reviews. eISSN, 2395-6518. https://www.researchgate.net/profile/Yazen-Mahmood/publication/337649574_THE_EFFECT_OF_JOB_SATISFACTION_AND_ORGANIZATIONAL_COMMITMENT_ON_NURSES’_PERFORMANCE/links/5de2499e4585159aa45479bd/THE-EFFECT-OF-JOB-SATISFACTION-AND-ORGANIZATIONAL-COMMITMENT-ON-NURSES-PERFORMANCE.pdf

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