One in a series of interviews with Modern Healthcare's Top 25 Women in Healthcare for 2015.
Patient-safety organizations have proliferated in the last decade, from the respected National Patient Safety Foundation to numerous groups founded by patients or their relatives who have experienced pain and loss from medical errors. Yet few have the muscle that the Leapfrog Group does, using its research and clout on behalf of businesses that pay for their employees’ healthcare coverage.
That marriage of safety and statistics, with a streak of blunt boldness, is personified by Leapfrog President and CEO Leah Binder, who has led the organization since 2008. She is a friend to many in the industry, but notes that Leapfrog fiercely guards its watchdog status.
“I think a lot of people who are involved in the healthcare industry also have tentacles into a lot of different interest groups that they need to maintain strong ties to,” she says. “And while we also like to maintain strong ties to and collaborate with our colleagues in healthcare, we maintain a strong independence from the industry. And that has enabled us to talk about reality in a way that is different from what others who are within the system feel able to do.”
While she is a champion of the quality care that many systems and physicians provide, she’s not afraid to take them to task when she feels U.S. consumers and their employers aren’t getting stellar treatment. Leapfrog’s voice has been getting louder and more urgent lately, Binder notes, because it hasn’t always seemed that the healthcare industry has been paying attention.
“When I am speaking from the perspective of a purchaser who is spending more money on healthcare than they earned in profits last year, they expect tough talk,” she says. “They want to make sure their employees are safe and healthy and they get the right value for their money. It’s just been very difficult to get that message out to the healthcare community that employers want change and expect it.
“I’ve certainly had to begin to communicate in ways that make clear that the business community considers this to be serious business.”
Binder got to know the Leapfrog Group when she was vice president of Franklin Community Health Network, a healthcare system in Maine that participated in Leapfrog’s surveys on quality and safety. Prior to that, she was a senior policy advisor to then-New York City Mayor Rudolph Giuliani. She began her career as public policy director for the National League of Nursing.
Her life-changing encounter with the importance of safety came when her infant son was sick, and she and her husband couldn’t get their pediatrician to listen to them.
“When he was 3 weeks old, he was misdiagnosed with acid reflux. The actual diagnosis was that he had pyloric stenosis which, if it goes untreated for too long of a period, can be dangerous if not deadly,” Binder remembers. “And it was only because of my husband’s aggressiveness in insisting on a re-evaluation of him that we were able to get him in for emergency surgery. And that probably saved his life.”
The episode made a deep impression on Binder and her family.
“It just showed me that when ordinary people like me make mistakes – perhaps we miss an appointment or forget to get milk from the grocery store – they don’t have a huge impact. But when you’re in healthcare, even minor mistakes can have catastrophic effects for people. That’s a lot of pressure on people who work in the healthcare system and it is a lot of responsibility. It made me realize just how important it is for us to respect that and to make sure that vigilance continues.”
The Leapfrog Group conducts its vigilance through the Leapfrog Hospital Survey, an annual report that tracks hospitals’ performance on safety, quality and efficiency. Its Hospital Safety Score also assigns letter grades – from A to F – to more than 2,500 U.S. hospitals.
While numerous groups create “top hospital” rankings each year – so much so that a provider can pick and choose which report shows it in the most favorable light – Binder says she believes one factor elevates Leapfrog’s reach beyond the others: transparency.
“Our transparency is absolute,” Binder asserts. “We make everything public by hospital and there are a number of groups working with hospitals that specifically do not make that data public. They collect it in order to work with it internally to improve the safety profiles of their members, and that’s certainly one model. We believe that transparency actually galvanizes improvement faster, but we support the fact that these other groups are working on it and we know they have had success.”
The other pressure that the Leapfrog Group brings to bear on safety and quality is financial in nature.
“We are working from the perspective of the purchaser, so we want to bring value-based purchasing into the equation,” Binder says. “We really want to start to tie payment to performance on key safety and quality metrics. Employers want to see results.”
Binder said she believes the industry has made significant progress on quality and safety, although she admits that the pace of change is uncomfortably slow. She is concerned about consolidation among providers and payers because she says the trend “traditionally has meant lower quality, higher costs.” But lasting change, she adds, has to come from the top, and she is not convinced healthcare CEOs have made safety the priority it should be.
“For me, when we start seeing CEOs believe their jobs are on the line if they can’t get the safety record better, that’s when we’re going to see rapid change,” she says. “I have heard directly from some CEOs who say that it was a very significant moment in their career when they saw the Leapfrog letter grade that reflected poorly on their hospital, and that spurred them into action. I’ve also seen some hospitals or systems that are putting CEO and senior-level compensation at risk based on their letter grade or their safety record, and that’s also a very positive sign. But we’re not there yet.”