The Leapfrog Group and the American Diabetes Association (ADA) partnered to launch an inpatient diabetes recognition program called Recognized Leader in Caring for People Living with Diabetes, which is now in its third year.
This is the first-ever national recognition program to recognize hospitals that go the extra mile for the safety and well-being of adults living with diabetes.
Adult and general acute hospitals and specialty hospitals that care for adult inpatients and submit a Leapfrog Hospital Survey are eligible to apply for the designation.
Shore Medical Center, a community hospital in New Jersey with 196 in-patient beds, is one of 36 hospitals to achieve the 2025 Recognized Leader in Caring for People Living with Diabetes designation.
In this case study interview, Jean-Luc Tilly, Program Director of the Leapfrog ASC Survey and Special Projects, speaks with Kris Liwoch, Senior Analyst, and Dr. Dan Jacoby, Director of Hospital Medicine for Shore Physicians Group and the Division Chief of Internal Medicine, at Shore Medical Center, about their organization’s journey.
Jean-Luc Tilly: To start, could you introduce yourselves and share your roles at Shore Medical Center?
Kris Liwoch: I’m Kris Liwoch. I’ve worked at Shore Medical Center for almost 40 years. I serve as the organization’s senior analyst and am also a Leapfrog Certified Coach.
Dan Jacoby: I’m Dr. Dan Jacoby. I serve as the Director of Hospital Medicine for Shore Physicians Group and the Division Chief of Internal Medicine at Shore Medical Center.
Jean-Luc Tilly: Congratulations on earning Leapfrog’s Recognized Leader designation last year. How did you first learn about the program, and what motivated you to apply?
Kris Liwoch: We’ve participated in the Leapfrog Hospital Survey for about 20 years. While working on the Survey, we saw information on Leapfrog’s diabetes recognition and were immediately interested. Continuous improvement is part of our culture, so we explored the requirements and decided to pursue the designation.
Jean-Luc Tilly: When you first reviewed the requirements, how did they compare to your existing practices, and what did that early assessment look like?
Kris Liwoch: We began with a comprehensive gap analysis—where we were versus where we needed to be. We convened a multidisciplinary group so every part of the process had a voice in the same room. That open discussion helped us realize we were already doing more than we thought; we just needed to connect the pieces. That multidisciplinary approach was essential to our success.
Jean-Luc Tilly: How did you assemble the core team, and what was your overall timeline from planning to submission?
Kris Liwoch: We started in 2023. At the time, our diabetes educator role was part-time, so we prioritized strengthening that function. Over six to seven months, we pulled policies and procedures, adjusted about 30 of them (none from scratch), and aligned workflows across the organization. Because the changes touched providers and multiple departments, the full implementation took about eight to nine months. We also secured leadership buy-in and an executive sponsor—our CMO, Dr. Galler. Support was strong because improving patient care and following best practices is core to Shore’s culture.
Jean-Luc Tilly: Which requirements or practice changes were most challenging or surprising—and what went especially smoothly?
Kris Liwoch: When we pulled our data, we found that 27% of our inpatients were either living with diabetes or newly diagnosed. The volume was striking. We sliced the data many ways to look for disparities and improvement opportunities—not just to meet the standard, but to strengthen care across the board, inside the hospital and out in the community.
Dan Jacoby: At a high level, we realized we were already performing many of the required elements—work our community might not fully recognize. In Atlantic County and South Jersey, about 11% of the population lives with diabetes, and nearly a quarter of our hospital patients are affected, so the potential impact was clear. The review helped us identify areas to ramp up further while showcasing strong outcomes we already had.
Jean-Luc Tilly: Can you share an example of a practice you scaled as part of this work?
Dan Jacoby: Perioperative A1C screening is a great example.
Kris Liwoch: Our orthopedic surgeons were already screening A1C effectively. We expanded that best practice to all surgical patients, both inpatients and outpatients, focusing on anyone without an A1C recorded within the prior three months. When results are concerning, we don’t say “cancel”—we say “defer.” We connect patients with diabetes educators and medical follow-up, optimize control and then move forward with surgery to reduce complications, skin breakdown and healing time.
Jean-Luc Tilly: What systems or technology changes did you make to support clinicians?
Kris Liwoch: We evaluated and refined our EHR to align with the new protocols without adding burden for frontline staff. IT, nursing, care management, nutrition services, pharmacy and clinical educators collaborated to update order sets and workflows so documentation supports the protocol—and clinicians can spend more time with patients, not computers.
Jean-Luc Tilly: How do you approach patient education, especially for people newly diagnosed during a hospital stay?
Kris Liwoch: We expanded our education team—we now have two diabetes educators—and trained bedside nurses, pharmacists and others to deliver complete, consistent education. Preserving appropriate patient independence is important; for example, if someone comes in with an insulin pump and it’s clinically appropriate, they can continue managing it. That control improves the patient experience.
Dan Jacoby: Diabetes management depends heavily on the patient, so individualized education is key. We built a dedicated inpatient diabetes care team led by nurse practitioner Althea Duna, who specializes in diabetes care and works closely with our endocrinologists. Discharge plans are personalized, readable letters—“Dear Mr. Smith…”—that list A1C, insulin or oral meds, diet and exercise guidance, and “what-to-do-if” scenarios. Patients bring these to follow-up visits, and engagement has been excellent. We also partnered with IT and medical records to produce clear, professional materials.
Jean-Luc Tilly: How do you address social needs and ensure a safe, timely transition at discharge?
Kris Liwoch: We screen every patient for health-related social needs—food security, ability to afford medications and transportation to follow-up. We connect patients with community resources and offer free community diabetes education so people have what they need to succeed after discharge.
Dan Jacoby: Readmission risk often hinges on access in the first 24 hours. We partner with manufacturers to maintain a charitable stock of insulins, other medications and CGMs for patients in need. We’ll set up CGM apps on a patient’s phone before discharge so they can see how meals and insulin affect glucose in real time. Those partnerships help bridge the gap from hospital to home.
Jean-Luc Tilly: What’s next for your diabetes program?
Kris Liwoch: We’ll sustain and strengthen the program, expand community outreach and continue monitoring for opportunities as new habits mature over the next one to two years. Medicine evolves quickly—new therapies require ongoing training in use and disposal—so we’ll keep pace with best practices.
Dan Jacoby: Continuing education is a priority—even for specialists not focused on metabolic medicine. We partner with university hospitals for CME, and recently hosted a session on newer medication classes and their implications for perioperative and specialty care. Our dedicated clinical team model—NP-led with endocrinology oversight—has produced strong outcomes and efficient resource allocation, so we’ll continue to track and optimize that.
Jean-Luc Tilly: What advice would you offer hospitals considering the recognition—or looking to strengthen inpatient diabetes care?
Kris Liwoch: Start with a thorough gap analysis to clarify where you are and where you want to go. Build a multidisciplinary team—IT, nutrition, pharmacy, surgeons, medical providers, nursing, educators, executives—because a change in one area affects the whole. Stay engaged, stay focused and keep up with evolving standards. Most hospitals are likely doing more than they realize; connecting the dots is powerful.
Dan Jacoby: Just do it. The process may seem daunting, but let the data guide you. We found we were closer than we expected, and the program improved workflows and outcomes while highlighting our focus on diabetes. Nearly every department contributed—from facilities (insulin storage) to executive leadership—which made it a hospital-wide success.
Jean-Luc Tilly: Any closing thoughts?
Kris Liwoch: The work was energizing because we knew we were improving care. We’re committed to maintaining and growing the program.
Dan Jacoby: Agreed. The process was clear and manageable, and the impact on patients and staff has been tremendous.
Jean-Luc Tilly: Thank you both for sharing such concrete, actionable insights. This will be immensely helpful for other hospitals pursuing the designation.