How Hospitals Address Diagnostic Errors: A Report from 95 Hospitals 

March 27, 2024

WASHINGTON, March 26, 2024—The Leapfrog Group today released Recognizing Excellence in Diagnosis: Leapfrog’s National Pilot Survey Report, which analyzes responses from 95 hospitals on their implementation of recommended practices to address diagnostic errors, defined as delayed, wrong or missed diagnoses or diagnoses not effectively communicated to the patient or family. The National Academy of Medicine has warned that virtually every American will suffer the consequences of a diagnostic error at least once in their lifetime and noted that 250,000 hospital inpatients will experience a diagnostic error every year.  

While progress varies considerably, more than 60% of hospitals responded that they were either already implementing or preparing to implement each of 29 evidence-based practices known to prevent harm from diagnostic error. The practices were identified in an earlier Leapfrog report, Recognizing Excellence in Diagnosis: Recommended Practices for Hospitals. The hospitals reported barriers to putting the practices in place that include staffing shortages and budgetary pressure.  

“We assume diagnostic errors will occur in every setting because people make mistakes. That’s why it’s so important for hospitals to have systems in place so those mistakes don’t harm patients,” said Leapfrog President and CEO Leah Binder. “Unfortunately, our report suggests hospitals have a long way to go in effectively addressing diagnostic errors. But they recognize the problem, and that’s encouraging.”

The report summarizes findings from a diverse cohort of 95 top performing hospitals that volunteered for the pilot survey. They were not randomly selected, so findings are not generalizable to all hospitals. Nonetheless, the findings offer important insights on the progress among hospitals most interested in improving diagnosis and most successful at achieving excellence in other aspects of quality and safety. 

Key findings include: 

  • Hospitals have made more progress in addressing issues in the diagnostic process than implementing leadership structures and systems to support improved diagnosis: On average, hospitals reported implementing 9 of the 16 practices (56%) in Leadership Structures and Systems and 8 of the 13 practices (62%) in The Diagnostic Process, despite practices concerned with The Diagnostic Process generally being more staffing- and resource-intensive. 

  • Leapfrog’s goal of public reporting on diagnostic excellence resonated with hospitals: Hospitals that participated in the pilot survey agreed that the issue of diagnostic excellence is important and that public reporting is a fundamental precursor to any meaningful change. 

  • Hospitals are receptive to tackling the problem of diagnostic error and exploring opportunities for improvement: For each of 29 recommended practices to address diagnostic error that hospitals were asked about, 60% or more hospitals responded that they were either already implementing or preparing to implement the practice. The average percentage of hospitals responding “Not Under Consideration” for a practice was 15%. 

  • Progress varies considerably and full implementation is lacking: Most participants were open to the practices recommended by Leapfrog and were taking at least preliminary steps to implement them. However, attainment of full implementation was rare, and many practices were not being widely considered for adoption. 

  • Hospitals need more specific guidance on improvement: Hospitals requested a hierarchical classification of practices that would describe a sequence of implementation. 

Based on these results from the National Pilot Survey, Leapfrog has included its first-ever questions on diagnostic excellence in the 2024 Leapfrog Hospital Survey, launching April 1. 

These questions will assess hospitals’ progress in implementing a limited number of recommended practices and reflect tangible actions hospitals should take to reduce diagnostic errors. In line with the longstanding Leapfrog policy, the questions will not be scored or publicly reported by hospital because they are new. 

“The pilot survey results indicate hospitals are ready to prioritize strategies to reduce diagnostic error, and that's a positive sign,” said Leapfrog Senior Vice President of Health Care Ratings Missy Danforth. “The next step is public reporting, which we know is critical to galvanizing improvement, and that's why questions about diagnostic error are going on the Leapfrog Hospital Survey this year.” 

“We now have a much better sense of the steps hospitals can take to address this problem. The interventions evaluated in this pilot study are a great start, and we hope to see many more hospitals joining in efforts to improving diagnostic quality and safety going forward,” said Mark L. Graber, MD FACP, a contributing author of the Report and co-chair of Leapfrog’s Recognizing Excellence in Diagnosis Advisory Group. “We are pleased to work with the Leapfrog Group on this initiative, as it advances our mutual goal of improved patient safety.” Dr. Graber is founder and president emeritus of the Society to Improve Diagnosis in Medicine (SIDM).   

More information about the 2024 Leapfrog Hospital Survey is available at  

About The Leapfrog Group 

Founded in 2000 by large employers and other purchasers, The Leapfrog Group is a national nonprofit organization driving a movement for giant leaps for patient safety. The flagship Leapfrog Hospital Survey and new Leapfrog Ambulatory Surgery Center (ASC) Survey collect and transparently report hospital and ASC performance, empowering purchasers to find the highest-value care and giving consumers the lifesaving information they need to make informed decisions. The Leapfrog Hospital Safety Grade, Leapfrog's other main initiative, assigns letter grades to hospitals based on their record of patient safety, helping consumers protect themselves and their families from errors, injuries, accidents and infections. For more, follow us on Twitter, Facebook, LinkedIn and Instagram and sign up for our newsletter.  

Leapfrog’s Recognizing Excellence in Diagnosis initiative was developed in collaboration with SIDM and is funded by a grant from the Gordon and Betty Moore Foundation. 


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