Friday, September 07, 2007

Rating Hospitals and Law School Faculties

Today's NY Times has a story detailing NYC's plan to make publicly available the infection and death rates at city hospitals. As decried in FindLaw columns by DoL blogger Sherry Colb (here and here), infections acquired in hospitals account for about 100,000 deaths a year, a truly staggering figure. Some hospitals have begun to take measures to address the problem, which is mostly a function of inadequate or lack of handwashing by medical staff. In his book Better, Atul Gawande explains that proper hygiene technique is observed in the OR but not in the rest of the hospital, mostly because doctors and nurses pressed for time find it too cumbersome. He describes successful measures to change medical staff behavior.

The NYC effort should complement one of Colb's proposals: By alerting the public to the danger, it will give hospitals incentives to improve hygiene. In this as in many other contexts (e.g., the Toxic Release Inventory, aspects of the more successful state public education reforms on which No Child Left Behind was based), requiring public disclosure of information can be a cheap yet powerful regulatory technique. Unfortunately, the NYC program doesn't (yet?) apply to private and not-for-profit non-state hospitals. Statewide or even federal legislation (valid under the Commerce Clause) imposing a reporting mandate would be extremely valuable here. To be sure, there is a risk of adverse selection and cheating in reporting (e.g., hospitals reporting staph infection deaths as something else) but there are ways of policing those behaviors. A single number---deaths due to hospital-induced infections---would make data very useful.

Meanwhile, Brian Leiter has just released his latest effort to measure the top US law schools by scholarly impact. As Leiter himself notes, it's a bit odd to measure scholarly impact by numer of citations of work. Among other problems he identifies, some works are cited because they make "classic mistakes." Although my home institution does reasonably well by Leiter's measure (5th overall mean citations; 6th median citations), the whole enterprise has the air of a popularity contest. True, it ranks institutions in a way that roughly correlates with my own general sense of their scholarly influence---but that's not really telling us anything, is it? We certainly would expect scholars at top schools to be cited a lot. What would be more useful to know---though just about impossible to quantify---is what scholars are writing terrific work that isn't getting noticed. The problem, I guess, is that "quality of legal scholarship" is a much more elusive concept than "deaths due to hospital-induced infection."

14 comments:

Brian Leiter said...

Michael, if you knew how the top 35 was going to come out already why didn't you tell me, and save me and the RA all that trouble!!!

Michael C. Dorf said...

Touche! To be fair to Brian, I should add that the rankings are pretty predictable only for the top 10 or so, and even there we find surprises (like how poorly Penn does). After the top 10 or so, there really do appear to be some large discrepancies between ranking as measured (even if necessarily crudely) by scholarly impact versus ranking by other measures (such as those used by USNews).

egarber said...

One thing I've always wondered about is how much treating such infections adds to the overall costs hospitals bear, which in the larger health care frame get passed on to the rest of us. If we're talking about 100,000 *deaths*, that must mean triple or four times that amount of actual infections (assuming most who contract these illnesses don't die), no? That's gotta add up.

Is that 100,000 number a national figure?

Mary L. Dudziak said...

Another concern about the study is the ways it might be used. Once something is "countable," and and both law schools and individual faculty are identified based on their numbers, some deans or faculty committees may want to move further up in the ranking, and reward activity that increases what's counted. But what Leiter counts excludes valuable law-related scholarship that is less likely to show up in citation counts in the database he uses, which is restricted to law reviews, nearly all of which are U.S. based. More on this -- arguing that law school faculties should aspire to broad scholarly impact, beyond the walls of the legal academy and beyond the nation’s borders -- is here: http://legalhistoryblog.blogspot.com/2007/09/what-leiters-study-doesnt-show-overall.html

Brian Leiter said...

I'd like to suggest, Michael, that even on the "top 10 or so" there are some surprises, esp. vis-a-vis a world defined by US News. It may not surprise someone like you, who is a highly engaged scholar, that schools like Texas and UCLA show up in the top ten for scholarly impact, but it must surely surprise all those nurtured on US News, where neither school has ranked higher than 15th in ages. That you found Penn's performance surprising might also (perhaps I am wrong) reflect an expectation created by US News's systematic over-ranking of what is certainly a very good law school, but plainly not one that is even remotely in the vicinity of Columbia or Chicago or NYU in terms of the acadmeic excellence of the faculty. No doubt those of us "in the know" have a gestalt sense of all these things, but most of those interested in law schools (intellectually serious students, administrators, elite members of the bar) are not "in the know" even with respect to the top ten. Or so it seems to me.

I take Professor Dudziak's concerns seriously, and plan to address them in a separate post on my law school blog. I do think that one way of establishing that something is "valuable law-related scholarship" is to show that legal scholars tend to cite it/rely on it in their legal scholarship, and so I am a tad skeptical about her underlying assumptions. (My impact on Nietzsche studies, to take an example close to home, is quite substantial as measured by citations, but that does not, alas, make it "valuable law-related scholarship," as much as I think Nietzsche ought to be a part of the first-year law curriculum!)

Mary L. Dudziak said...

I look forward to hearing more from Brian Leiter about these issues on his blog. But let's not assume that the work published in non-law journals is not law related. After all, it was one of my Journal of American History essays that Justice Breyer cited to in the PICS case. There are many citations to my work on the impact civil rights on Cold War foreign affairs, especially my book, in non-law journals and non-U.S. journals. My concern is that deans and/or law school committees will create disincentives discouraging junior interdisciplinary faculty from publishing in the leading non-law journals that enable them to become leaders in their Ph.D. fields. That broad-based intellectual leadership will be law-related. Many corners of the academy are interested in law.

Frank said...

I agree that the infection data should be public knowledge, but I also worry that some forms of hospital rankings (such as more general outcome data) lead hospitals to shun the sickest:

http://www.concurringopinions.com/archives/
2007/07/doctor_ratings.html

Here's a bit from the NYM story quoted in that post:

"The first significant study to suggest that all was not right with the new system [of hospital assessment] arrived in 1996, when researchers at the Cleveland Clinic suggested that some of the sickest New York heart patients were being shipped out of state. In the first few years after the report-card program began, the Cleveland Clinic received 31 percent more referrals from New York hospitals than they had previously received—and the study verified that the New York patients were sicker than those who were referred from other states."

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