The effect of public accountability on hospital performance: trends in rates for cesarean sections and vaginal births after cesarean section in Cleveland, Ohio

The article reports a study that was designed to identify whether hospitals in the Cleveland, Ohio area have responded to public concern about improving their cesarean section and vaginal birth after cesarean section (VBAC) rates. A 14-item survey based on the Joint Commission on Accreditation of Healthcare Organizations' 1997 Codman Quality Award was administered to 20 hospitals. Respondents self-scored the survey based on a 5-point Likert scale. Three hospitals provided a detailed description of their efforts. Results showed that all hospitals are at various stages of the process to improve their cesarean section and VBAC rates. From this, it is proposed that public accountability encourages quality improvement.