Mirror, Mirror on the wall, who is the best of us all?

Conventional wisdom suggest that bigger and more sophisticated hospitals offer the best care. However, my anecdotal experience suggest that this may not always be the case. There are some emerging data which also put the lie to this hypothesis. Just published is The Joint Commissions annual survey of hospital quality in the US.
The measures used to assess quality might be criticized as “process“ measures, i.e. Are we delivering the care that we are supposed to deliver? but these are basic widely agreed measures. The most stunning finding was that many of the big name hospitals, even those that have tried to make their name as institutions that prioritize quality and safe care do not feature. Or maybe not so surprising; in a culture in which individuals prize their autonomy, it will be easier for smaller hospitals to ensure they are consistent in applying processes.