We know that most problems in hospitals are not due to one bad doctor or one bad nurse. Problems come from the systems in the organization. And by looking at the performance of the whole organization, we're able to look at those hospitals that have goals for true performance, leadership that stands behind it ...

What we were able to identify over five years is that hospitals that won more than once had a pure focus on continuous quality improvement. What the consumer can depend on with this list is that these hospitals are consistently good performers.

What we are trying to achieve is to identify those hospitals that perform well under adverse conditions, such as managed care, as opposed to those that perform well under the old system of cost-plus, or Medicare. We look at the quality of care for patients, and their efficiency in adapting to the health care environment.

This year's study reflects the financial distress hospitals have encountered in the wake of the Balanced Budget Act of 1997. Despite the difficulties facing them, the 100 top benchmark hospitals have maintained profitability and top clinical performance.

A hospital should also have a recovery room adjoining the cashier's office.

One of the most difficult things to contend with in a hospital is the assumption on the part of the staff that because you have lost your gall bladder you have also lost your mind.