20 years of Quality & Accountability: A benchmark for top-performing hospitals

For 20 years, Vizient’s Quality & Accountability (Q&A) Study has helped answer one of healthcare’s most pressing questions:

Why do some organizations consistently deliver exceptional care while others struggle?

Launched in 2005, the study revealed something powerful — the best hospitals weren’t just excelling by chance. What emerged was a clear pattern. Top performers shared common traits: a clear sense of purpose, accountable leadership, a focus on results and a culture of collaboration.

Over the next two decades, the Q&A Study has become more than a ranking: It’s a touchstone — a benchmark and “North Star” that continues to guide health systems striving for better outcomes across safety, efficiency, effectiveness, equity and patient-centered care. Using the Vizient Clinical Data Base (CDB) alongside Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results and data from the Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN), the rankings are weighted and risk-adjusted annually to keep pace with evolving standards of care. Each fall, top-performing client organizations are recognized at the annual Vizient Connections Summit.

Over 20 years, this award has grown from evaluating 90 academic medical centers to more than 1,000 hospitals. Being recognized today means excelling among a large field of peers. These awards reflect more than numbers — they represent high-quality patient care, strong outcomes, and the shared purpose, accountability and collaboration that drive organizational success.

Julie Cerese

Senior vice president,
performance management and national networks at Vizient

‘Practices that lead to better outcomes’

From the start, the Q&A has balanced regulatory alignment with innovation — going beyond CMS-required measures to create actionable, fine-tuned metrics that drive performance improvement.

“There are real opportunities for health systems to understand what success looks like. Success doesn’t mean excelling in every measure — even top performers have opportunities for improvement,” said Eric Hixson, vice president of data and methodology at Vizient. “What matters is progress and the pace of that progress relative to peers.”

Cerese adds, “It’s friendly competition, but more importantly, it’s about sharing practices that lead to better outcomes.”

While many healthcare organizations achieve top performance across multiple domains for a short period of time, sustaining those achievements year after year can often be a challenge. Since the original study in 2005, Vizient has conducted several additional studies of member academic medical centers to add to the body of knowledge about the unique characteristics of top-performing organizations.

Findings from the subsequent studies corroborate and reinforce the importance of shared purpose, leadership, accountability, collaboration across the organization and a focus on benchmarking and improvement.

• Shared purpose: Hospital leaders continually articulate that patient care must be the focus, and decisions are made at all levels of the organization to reflect that. Leaders and staff from the top to the bottom are committed to developing a culture of continuous improvement. Service excellence is considered a priority, which results in high quality and safety care.
• Leadership style: The CEO leading the organization is passionate about service, quality and safety, and has an authentic, hands-on style. Everyday events at the unit and department level and individual patient interactions are connected to the larger, guiding purpose through stories and rituals. This enables the goal-oriented and evidence-based communications. Governance structures and practices of alignment and consistency minimize conflict. The institution is led as an alliance between the executive leadership group and clinical department leaders or chairs. Goals are created collaboratively and with insights from all types of team members.
• Accountability systems: Prioritizing, developing measures and setting goals are centralized, and the tactics to improve those metrics are decentralized throughout the organization. The department chairs accept responsibility for quality and safety within their own departments. There are also accountability innovation, empowerment and redundancy at the unit level.
• Focus on results: There is a relentless effort to improve, employing performance against external standards as a measure of success. The results are more important than navigating the approach to performance improvements. The organization focuses on systems and processes redesign as the keys to improvement. Technology is used as a supporting point, to accelerate improvement, not as the solution.
• Collaboration: Collaboration characterizes the relationships between administration, physicians, nurses and other staff. The organization leaders at every level regularly recognize contributions of employees. Regardless of title or role, staff treat each other with respect and understand each employee is bringing critical knowledge when problem solving.

Over the years, our insights have shown that respect and close collaboration between physicians and nurses, transparency with board members, and their active support — especially when focused on key metrics and reinforced by strong communication across the organization — are essential. The linchpin of every top-performing organization is its unwavering focus on delivering a high-quality patient experience.

Dr. David Levine

Chief medical officer at Vizient

Data as a change driver