Skip to main content

The Leapfrog Group: 33% of U.S. Hospitals Earn "A" Grade for Patient Safety

Analysis  |  By Christopher Cheney  
   May 10, 2022

The watchdog group also released a report that shows patient experience in the inpatient setting has declined significantly during the coronavirus pandemic.

The Leapfrog Group conducted an analysis of 2,844 U.S. hospitals, and one-third of the facilities earned an "A" grade for patient safety.

Patient safety has been a pressing issue in healthcare since 1999, with the publication of the landmark report To Err Is Human: Building a Safer Health System. Despite two decades of attention, estimates of annual patient deaths due to medical errors have risen steadily to as many as 440,000 lives, a figure that was reported in the Journal of Patient Safety in 2013.

Today, The Leapfrog Group released its latest grades for hospital patient safety. The analysis utilizes more than 30 measures, including the PSI 90 Patient Safety and Adverse Events composite, which features 10 component measures.

The Leapfrog Group was founded in 2000 by large employers and other purchasers of healthcare. The nonprofit group publishes reports on hospital patient safety in the fall and the spring.

The distribution of letter grades for the hospitals in the spring report is as follows:





F…Less than 1%

The Top 10 states by percentage of "A" grade hospitals are as follows:

1. North Carolina (59.8% of hospitals with an "A" grade)

2. Virginia (59.2%)

3. Utah (55.6%)

4. Colorado (55.3%)

5. Michigan (50.6%)

6. Idaho (tied at 50.0% of hospitals with an "A" grade)

6. Massachusetts (tied at 50.0% of hospitals with an "A" grade)

6. Hawaii (tied at 50.0% of hospitals with an "A" grade)

9. Oregon (47.1%)

10. Pennsylvania (45.9%)

Four states and the District of Columbia had no hospitals with an "A" grade: North Dakota, West Virginia, and Wyoming.

Seventeen hospitals received an "F" grade:

  • Shoals Hospital, Muscle Shoals, Alabama
  • Barstow Community Hospital, Barstow, California
  • Henry Mayo Newhall Hospital, Valencia, California
  • Pacifica Hospital of the Valley, Sun Valley, California
  • Pioneers Memorial Hospital, Brawley, California
  • San Joaquin General Hospital, French Camp, California
  • Howard University Hospital, Washington, District of Columbia
  • Halifax Health Medical Center - Port Orange, Port Orange, Florida
  • Vista Medical Center East, Waukegan, Illinois
  • Southwest Medical Center, Liberal, Kansas
  • Byrd Regional Hospital, Leesville, Louisiana
  • Jennings American Legion Hospital, Jennings, Louisiana
  • Granville Medical Center, Oxford, North Carolina
  • Great Plains Regional Medical Center, Elk City, Oklahoma
  • Baylor Scott & White Medical Center—McKinney, McKinney, Texas
  • CAMC General Hospital, Charleston, West Virginia
  • CAMC Teays Valley Hospital, Hurricane, West Virginia

Effects of the coronavirus pandemic

The pandemic has had a grave impact on hospital safety, for both patients and health workers, Leah Binder, MA, MGA, president and CEO of The Leapfrog Group, told HealthLeaders.

"As a recent New England Journal of Medicine article authored by Centers for Disease Control and Prevention as well as Centers for Medicare & Medicaid Services leadership found, the stress of the pandemic—from burnout to shortages—has reversed years of patient safety progress, most notably regards to healthcare-acquired infections and patient experience. Comparing the fall 2021 and spring 2022 rounds, we saw that three infection measures—central line-associated bloodstream infection, catheter-associated urinary tract infection, and methicillin-resistant Staphylococcus aureus—worsened by a statistically significant amount. The pandemic has revealed that we must build a more resilient culture of safety," she said.

Hospitals need to take action to get patient safety back on track, Binder said. "Hospital leadership and boards must make patient safety a top priority. They need to be transparent and hold themselves accountable for progress. That means hospitals need to recommit to the patient safety basics—proper hand washing, infection prevention, communication, and medication safety to name a few—and fortify safety culture from the top down. An aggressive approach to patient safety can help reduce burnout, which is directly associated with staffing shortages."

State of patient experience

In addition to the hospital safety grades report, The Leapfrog Group also released today a report on adult patient experience in the inpatient setting. The watchdog group analyzed data collected in the Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) survey.

The patient experience report includes three key findings:

  • During the pandemic, patient experience in the inpatient setting has declined significantly in nearly all measures
  • Patient experience in the care transitions metric remains the least favorable measure and declined significantly during the pandemic
  • Declining metrics of patient experience are associated with patient safety indicators, which indicates the pandemic has had a negative effect on hospital patient safety

Patient experience in the inpatient setting has declined across the board during the pandemic, Binder said. "This is deeply disturbing. Research has shown that hospitals that score higher on these patient experience measures tend to have better safety outcomes. For example, effective patient communication with nurses and doctors can prevent errors like medication mix-ups or misdiagnoses. Hospitals with better staff communication ratings have been shown to also have lower rates of hospital-acquired conditions. Additionally, if a patient is in pain, experiencing new symptoms, or cannot reach the bathroom, it is critical that staff respond quickly."

The largest difference comparing adult patient experience in hospitals pre-pandemic and mid-pandemic is in "responsiveness of hospital staff," which experienced a 3.7-point HCAHPS score decrease. Hospitals and patients can act to address this problem, she said.

"There are several ways hospitals can improve, but the first step they need to take is ensuring appropriate staffing levels. When hospitals don't have enough nurses, for example, patients might face greater risk of harm. Additionally, patient safety is a team sport—patients and hospitals will need to work together on this. While hospitals work to ensure appropriate staffing and care, patients, families, caregivers, and loved ones also play an important role. Patients should be encouraged to bring a caregiver along to act as a second set of eyes and ears. Hospitals should engage patients in every aspect of care, and the Agency for Healthcare Research and Quality, among others, offer extensive resources that hospital staff can utilize."

Related: Workforce Shortages Identified as Top Patient Safety Concern of 2022

Christopher Cheney is the CMO editor at HealthLeaders.


North Carolina hospitals led the country in hospital patient safety, with 59.8% of hospitals earning an "A" grade.

Seventeen hospitals were assigned an "F" grade.

Hospital patient safety has declined significantly during the coronavirus pandemic.

Get the latest on healthcare leadership in your inbox.