Hospitals in Waterloo region have earned an overall B grade in a Canadian national hospital performance report card compiled by CBC's the fifth estate.

Grand River Hospital, Cambridge Memorial Hospital, St. Mary's General Hospital and Guelph General Hospital all received B-grades.

Grand River Hospital earned an A+ for readmission after surgery, but was given a D for nursing care for medical patients. The latter category is associated with adverse events such as bed sores, urinary tract infections and pneumonia. Guelph General Hospital earned B grades across the board, as did Cambridge Memorial Hospital, with the exception of an A+ for readmission after surgery.

St. Mary's General Hospital in Kitchener earned a range of grades, from an A+ for readmission after medical treatment to a D for mortality after major surgery.

CBC'S Rate My Hospital report card graded nearly 240 acute-care hospitals across the country, providing a snapshot of how hospitals are performing. Hospitals in Alberta, New Brunswick, Manitoba, Ontario and Saskatchewan are represented in the top 10.

CBC based its assessment on data collected from hospitals by the Canadian Institute for Health Information (CIHI), a publicly funded, non-profit organization that gathers and analyzes data on Canadian hospital performance. A five-member expert panel advised CBC on the selection and use of the data.

Data used by the CBC included rates of patients who died after major surgeries, who were readmitted after treatment and who experienced unexpected complications, known as adverse events, tied to nursing care during a hospital stay.

Community hospitals were compared against similarly sized facilities in three peer-group categories developed by the health-care industry while teaching hospitals made up a separate category.

Hospital report cards can be controversial because of the variety of methodologies and data used and the lack of a standardized approach.

But if done well, they can "focus hospitals' and clinicians' attention on important quality of care issues that need improvement," says Jack Tu, a cardiologist at the Schulich Heart Centre at Sunnybrook Hospital in Toronto. Tu was a member of the expert panel that advised CBC on the Rate My Hospital project.

"Every hospital wants to do well on these reports, and so by making this information public, it can help to galvanize hospital administrators and clinicians into making the necessary system changes to improve their performance," Tu said.

The key to making the best use of hospital report cards is to recognize their shortcomings but still learn from them, says fellow panelist Alex Bottle, a senior lecturer in medical statistics in the School of Public Health at Imperial College London who devised the statistical methodology for tracking patient outcomes used by Dr Foster Intelligence.

"Even noisy data and imprecise indicators can make a real difference if people acknowledge that they're flawed but that they may contain