Hospitals Receive A, B, C, D or F Scores for Patient Safety

June 6, 2012

Approximately 400 people die every day because of hospital errors—the equivalent of a jet crashing every day and killing all aboard. In response to this silent epidemic, more than 2,600 U.S. hospitals will now receive an A, B, C, D or F Hospital Safety Score based on patient safety via a first-of-its-kind initiative. A Blue Ribbon Panel of the nation's top patient safety experts provided guidance to The Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits, to develop the Hospital Safety Score. The Hospital Safety Score is calculated using publicly available data on patient injuries, medical and medication errors, and infections.

"The Leapfrog Group's goal is to give patients the vital information they need and deserve before even entering a hospital," said Leah Binder, president and CEO, The Leapfrog Group. "We hope people will use this score to talk with their doctor, make informed decisions about where to seek care, and take the right precautions during a hospital stay."

For the first time, the Hospital Safety Score will highlight the country's best hospitals and warn against the worst to save lives and bring attention to the nation's silent safety epidemic. According to recent studies, one in four Medicare patients will leave a hospital with a potentially fatal issue they didn't have prior to hospitalization. On average, one medication error per day occurs for each hospitalized patient, and more than 180,000 Americans die every year from hospital accidents, errors, and infections.

The Hospital Safety Score website allows visitors to search hospital scores for free, and also provides information on how the public can protect themselves and loved ones during a hospital stay. More information on the Hospital Safety Score can also be found on Sharecare, an online resource of health questions and answers. Patients should visit the Sharecare website for detailed questions and answers on how to stay safe and protect themselves during a hospital stay.

"The Leapfrog Group board has been frustrated with the lack of progress in improving patient safety, despite significant industry efforts over the past decade," said David Knowlton, immediate past chair of The Leapfrog Group Board of Directors and chair of The Leapfrog Group's Patient Safety Committee. "It is time for a game changer. It's time to give American families the heads-up they need to protect themselves if they face the need for a hospital stay."

The Leapfrog Group's membership of employers and other purchasers of health benefits, and business coalitions on health across the country, will be working to engage communities, employers, health plans, and hospitals in using the Hospital Safety Score to improve safety. The Hospital Safety Score will be reissued using updated data in November 2012, with an annual Hospital Safety Score to follow in 2013 and beyond.

Key Findings

  • Of the 2,652 general hospitals issued a Hospital Safety Score, 729 earned an A, 679 earned a B, and 1243 earned a C or below.
  • A wide range of hospitals earned As, with no one class of hospitals dominating among those showing the highest safety scores. Hospitals earning an A include academic medical centers Massachusetts General, NYU Langone Medical Center, and University of California San Francisco. Many rural hospitals earned an A, including Grinnell Regional Medical Center in Iowa and Baptist Health South Florida Homestead Hospital in Florida.
  • Hospitals with myriad national accolades, such as Mayo Clinic, Virginia Mason Medical Center, and University of Michigan Medical Center, each earned an A.
  • Less predictable were the A scores earned by hospitals serving highly vulnerable, impoverished, and/or health-challenged populations, such as Bellevue Hospital, Montefiore Hospital, and Detroit Receiving Hospital.
  • A scores were awarded to for-profit hospitals including many in the HCA systems, as well as hundreds of not-for-profit and public hospitals.
  • Community hospitals showed excellence as well, such as OSF St. Joseph Medical Center in Illinois. 

Not all hospitals earned an A, and there are some surprises, including hospitals with outstanding reputations for quality appearing with Hospital Safety Scores of B, C or below. The Hospital Safety Score exclusively measures safety, meaning errors, accidents, and infections. "Even hospitals with excellent programs for surgical and medical care, state-of-the-art diagnostic equipment, and dedicated physicians may still need this score as a reminder that patient safety should be a top priority," said Dr. Ashish Jha of Harvard, a member of the Blue Ribbon Expert Panel.

States had variations in performance. Massachusetts hospitals on average had the highest Hospital Safety Scores, while District of Columbia had the lowest average scores.

Methodology and Experts

Calculated under the guidance of The Leapfrog Group's nine-member Blue Ribbon Expert Panel, the Hospital Safety Score uses 26 measures of publicly available hospital safety data to produce a single score representing a hospital's overall capacity to keep patients safe from infections, injuries, and medical and medication errors. The panel includes: John Birkmeyer (University of Michigan), Ashish Jha (Harvard University), Lucian Leape (Harvard University), Arnold Milstein (Stanford University), Peter Pronovost (Johns Hopkins University), Patrick Romano (University of California, Davis), Sara Singer (Harvard University), Tim Vogus (Vanderbilt University), and Robert Wachter (University of California, San Francisco). 

"Developing the Hospital Safety Score was an intensive nine-month process led by a group of patient safety experts from across the country, and we believe it resulted in a fair metric to assess a hospital's performance on patient safety,"said Dr. Jha. "There is an overwhelming amount of information out there that could be useful when we are admitted to the hospital, but very few of us know what it is or where to find it. Everyone deserves the same information to protect their families. We've been glad to guide The Leapfrog Group in developing the Hospital Safety Score to give the public a way to guide their own decisions."

The Blue Ribbon Expert Panel designed the methodology for hospitals with the most data publicly available at the national level: general short-stay hospitals. As a result, excluded from this first round of the Hospital Safety Score are critical access hospitals, specialty hospitals such as children's hospitals and cancer hospitals, government hospitals such as VA and military hospitals, and long-term care facilities.

To develop the Hospital Safety Score, the Blue Ribbon Expert Panel gathered data publicly reported at the national level, including measures reported by the federal government via the Centers for Medicare and Medicaid Services (CMS) and the annual Leapfrog Hospital Survey. The final 26 measures calculated in the Hospital Safety Score cover falls and trauma, central line-associated bloodstream infections, very severe pressure ulcers, and preventable complications from surgery such as foreign objects retained in the body, postoperative hazards, and accidental punctures or lacerations. The Hospital Safety Score also credits hospitals on measures of the procedures and protocols known to prevent infections, errors and accidents, such as strong nursing leadership and engagement, hand hygiene policies, computerized physician order entry systems, adherence to medical and medication protocols that prevent complications, safety-first organizational leadership and culture, and the right level of staffing for the ICU.

Not all hospitals make the full list of 26 measures publicly available, in which case the Hospital Safety Score was calculated only for the available measures. The Blue Ribbon Expert Panel required at least 14 measures for a hospital in order to calculate a Hospital Safety Score. Those without 14 measures were not scored. Unscored hospitals include all hospitals from the State of Maryland, and certain territories including Guam and Puerto Rico, which the federal government excluded from required public reporting at the national level.

"Residents of Maryland, Guam, and Puerto Rico should be very concerned that they do not have information on safety that other U.S. residents have," said Binder, a Maryland resident. "We will be working to improve hospital transparency, and people should contact their elected officials and local hospitals to insist on better public disclosure."

For more information about the Hospital Safety Score, please visit


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