They are on a streak they know can't last.
Administrators at Johns Hopkins Hospital had been trying to persuade themselves in recent weeks that it wouldn't matter if the hospital slipped from its No. 1 position, eight years running, in U.S. News & World Report's annual rankings.
So they planned two strategies. Under Option A, posters and banners would proclaim Hopkins' top standing. Option B? The posters and banners would simply say the hospital was among the best.
To great relief yesterday, Hopkins learned its crown was safe, at least for another year.
"Every year it gets a little more nerve-wracking," said Dr. Edward D. Miller, dean and chief executive of Johns Hopkins Medicine. "There should not be this much angst over this. At a certain point, we know we'll probably have to fall out of this position, but I'd just rather not have it happen on my watch."
As men and women of science, the people at Hopkins know the magazine's survey is somewhat arbitrary.
Some health care experts criticize the ratings as crude measures of quality. And marketing consultants and hospitals, including Hopkins, say the ratings don't bring many new patients, because most go to centers that their doctors recommend and their insurance policies cover.
Still, it's hard to let go of the title.
"I think it's a big deal. Everybody wants to maintain it," says Patty Persuhn, a longtime pediatric nurse at Hopkins.
In the past few weeks, administrators have primed staffers for the announcement, hanging fliers in elevators and sending e-mails. From security guards to therapists and those who deliver the patients' flowers, employees wondered, and worried.
Department heads tried to prepare themselves for a possible defeat, telling themselves that if the magazine calculated the rankings a different way, their rival to the north, Massachusetts General Hospital in Boston, might come out on top.
Miller and Ronald R. Peterson, the hospital's president, sent out a letter to staff members last week, telling them to keep the rankings in perspective.
"Whether a hospital is No. 1 or No. 10 is insignificant," the letter said. "We know that the reason you do your best every day isn't the magazine's rankings."
Yet, like nominees for the Academy Awards who publicly declare that it's an honor to finish among the top, no one at Hopkins wanted to be like Minnesota's Mayo Clinic, which finished a frustrating No. 2 for the ninth year in a row.
Hopkins finished No. 2 the first year of the survey, 1990. But each magazine cover since 1991 is enlarged and framed behind glass in the hospital's main lobby and its outpatient center. Some employees say the honor drew them from other hospitals.
Medical centers nationwide salivate over Hopkins' status. The project's editor at U.S. News & World Report said he receives dozens of calls every year from hospitals whose presidents and trustees want to know how to join the rankings or how to improve their standing.
When Peterson was called at 6: 30 a.m. yesterday with the news, his first question was, "What's the point spread?"
4 first-place specialties
The magazine ranked the top 50 hospitals in each of 16 specialties. Hopkins ranked first in ophthalmology, gynecology, urology, and ear, nose and throat. It was in the top 10 in all but two categories -- rehabilitation, which ranked 19th, and respiratory disorders, which did not make the cutoff.
Other local hospitals also made the rankings. Sinai Hospital was 41st in geriatrics and 45th in hormonal disorders. Sheppard and Enoch Pratt Hospital was 10th in psychiatry. Greater Baltimore Medical Center was ranked 31st in cancer, and Johns Hopkins Bayview Medical Center was 29th in hormonal disorders.
The 13 hospitals ranked best overall included Mass General, the Cleveland Clinic, Duke University Medical Center, University of California, Los Angeles, Medical Center and the University of Michigan Medical Center.
Avery Comarow, the U.S. News editor supervising the rankings, said all 13 are excellent, and it would be impossible to say whether one was better than the other.
"To say that Hopkins is absolutely a better hospital than Mayo or the others would be ridiculous. These lists are starting points," Comarow said. "The horse race aspect of all this is something I don't like. Maybe it was naive of us here not to expect that."
U.S. News & World Report surveyed all 6,299 hospitals nationwide, selecting those that were either teaching hospitals, affiliated with teaching hospitals or had a considerable amount of medical technology.
Each hospital then was graded in three areas: its reputation among 2,400 board-certified physicians, mortality rates and other data that included such measures as nurse staffing ratios and the volume of procedures.
`Potential for arrogance'
The project is meant not as a guide for routine care, such as having a baby or getting an appendix removed, Comarow said, but for patients who need the best possible care because they have a difficult diagnosis, a complicated treatment or are getting experimental therapy.
But some of the honorees were troubled by the effort.
Dr. Charles W. Cummings, director of Hopkins' otolaryngology department, which was ranked No. 1, fears that the rankings and the oversized magazine covers displayed in the lobby will give false hope to patients entering Hopkins with incurable illnesses. He also worries that some people at Hopkins will believe too much of their own press.
"There is a potential for arrogance. The more times you tell people they're No. 1, they're more likely to act like it," Cummings said.
"If people choose to think you're No. 1, that's an honor that should be worn with great modesty."
Pub Date: 7/09/99