On 15 November 2009, The Week released its annual list of the country’s best hospitals, ranked by various specialties like cardiology, oncology, orthopedics, gastroenterology, ophthalmology and paediatrics.

The ranks are based on 14-city survey conducted by The Week in collaboration with IMRB, the market research agency, among 10 specialists across 10 specializations and 1190 general practitioners. According to the survey, All India Institute of Medical Sciences, Delhi -a hospital with an annual funding of about Rs. 7000 million from the Government of India- is the best hospital in the country. Several well-known hospitals, both from public as well as private sector also find a place in top 10.

We do not know if these ranks are based on scores for quality and efficiency. There is no mention of the study design and methodology used by the researchers to identify the top 10. And that makes me doubt the accuracy of the survey.

To ensure that the surveys use objective measures to assess a hospital, their survey techniques should be accurate and reliable. First, their sample should represent the community. Second, they should use outcomes that matter most to an individual patient. Third, they should also factor in patient’s satisfaction with the quality of care.

How are the best hospitals in the US judged? The variables used to assess US hospitals include death rates, medical complications, patient safety incidents, medical errors, outcomes adjusted to severity of diseases and average hospital stay. For example, when The Johns Hopkins Hospital earned the top spot among 4800 hospitals in the US this September, researchers looked at five metrics that gauge clinical quality and efficiency: death rates, medical complications, patient safety, average length of stay, and adherence to clinical standards of care. When researchers use such objective benchmarks, they can do an unbiased assessment of the care the hospitals provide to their patients, relative to others across the country. In addition, researchers also accord a lot of importance to the patients’ satisfaction. The Week survey instead ranks hospitals purely on reputation and some anecdotal success stories, as if objective parameters to rank the hospitals do not exist!

Why should researchers never rely on reputation alone? A small group of prominent hospitals in each specialty receives such high scores that they automatically occupy the top of the rankings, regardless of outcome score. And therefore, several public hospitals in the country, providing quality healthcare at low-cost are left out.

David Dranove recently wrote in JAMA that magazines often design and publish Best Hospital surveys to sell their magazines or advertise space. True, as I browsed through The Week, I found full-page multi-coloured advertisements from several hospitals: Nethradhama superspeciality eye hospital (Bangalore); Sir Ganga Ram hospital (Delhi); Apollo BSR hospital (Bhilai); Columbia Asia (Bangalore) MGM New Bombay hospital (Vashi) and GEM hospital (Coimbatore). Is it sheer chance that that some of these hospitals were also listed in the survey as among the best hospitals in the country?

Are these hospitals indeed the best places for patients seeking affordable and appropriate healthcare? Do these hospitals indeed practice evidence- based and patient-centered medicine to prevent, diagnose and treat human illnesses? Are such surveys really capable of identifying the best hospitals for millions of poor people in the country? I doubt.