Delivered on December 15, 2025 at the 2025 Leapfrog Annual Meeting and Awards Dinner. See video here.
Last night we lit the candles for the first night of Hannukah.
During Hannukah we Jews remember a great battle won against long odds.
There are rituals to the holiday that allow us to experience and pass along to new generations the memory and joy of that moment in history.
All Jewish holidays include one ritual that is actually the very centerpiece of Hanukkah: the lighting of candles.
In fact Hannukah is called the Festival of Lights. We light a new candle for each of the eight nights of Hannukah.
Light as a centerpiece of ritual is not only in Judaism of course but in every major religion. Genesis begins with God saying “let there be light.”
More secular physicists and engineers are focused on light as well.
At the tiniest levels, light is a bunch of individual particles and light is also a bunch of waves. Here’s the illogical part: light appears as particles or waves depending on the perspective of the observer. I’m not making that up—ask any physicist. That is the core scientific premise that ultimately powers your iPhone and that gave us AI.
Light is also part of our language and our poetry. Martin Luther King said, “Darkness cannot destroy darkness, only light can do that.” That is a beautiful metaphor, but it’s also a basic reality.
The mission of The Leapfrog Group is light.
We call it transparency, and we say it galvanizes change.
Transparency is light shining through.
Leapfrog’s mission is to shine light on the problems and the strengths in health care. We look for places of darkness, where people are suffering and dying from a preventable error for instance, and where there is an effort to obscure that tragedy from view. Then we bring light.
Leapfrog was founded 25 years ago on the principle we learned from Genesis, that if you are going to make a giant leap in anything, you must start with light. Let there be light.
You need a lot of other things to follow from that, but first you need light.
For decades people have poured their heart into ending preventable death and suffering in our health care system.
Many have been frustrated that while there are pockets of progress, the overall picture remained frustratingly the same. Patient safety was bad and the more we learned about it the worse it looked.
The founders of Leapfrog said what’s missing in health care is transparency. They were executives in other industries, like automakers and retail, and they said their products and services are held to the highest levels of transparency in an open market where consumers compare them. That’s made them better.
But Leapfrog’s transparency agenda was an experiment in the early aughts. Nobody had ever tried that in health care. We didn’t know if it would work.
There was a lot of scoffing and skepticism.
Our founders like Bob Galvin, who is here today and Arnie Milstein and Suzanne Delbanco of blessed memory, and Bruce Bradley and Lucien Leape who we lost just this year, were not stopped by the challenge of the unknown.
They said let’s just ask hospitals to tell us how they are doing. Thus was born the Leapfrog Hospital Survey, and public reporting by hospital on whether or not hospitals met the highest standards of patient safety.
When I started at Leapfrog in 2008 one of my first appearances on Capitol Hill was testifying at a hearing on hospital-acquired infections. Three other leaders leaders also testified, and it’s actually where I first met Dr. Peter Pronovost.
The core of my testimony, as was always the core of Leapfrog’s statements everywhere: we need transparency. We were calling for public reporting by hospital on infections. In 2008, this was a pipe dream.
Then around 2010 transparency took hold. CMS began reporting on adverse events and infections by hospital. That allowed Leapfrog to launch the Hospital Safety Grade in 2012.
Many of the board leaders you saw earlier were instrumental in getting the Safety Grade off the ground like Dave Knowlton who was board chair at the time and Rob Moroni on our executive committee. It wasn’t easy.
But here’s what happened. Change. We saw movement forward, lives saved.
The transparency experiment was finally working.
Not as much as we need, and the problem of errors, accidents, injuries and infections is still terrible.
One in four people admitted to a hospital suffer some form of unintended harm.
In the auto industry, a defect rate of one in a million is considered high enough to be worrisome.
And truly, would any of us get in our car if we thought we had a one in four chance of getting hurt in the drive?
So health care has a long way to go.
But still, we are seeing movement and that is a true breakthrough. In this decade of the transparency experiment, according to a JAMA study involving tens of thousands of patient records, there have been 20 and 30 percent reductions in healthcare-associated infections and many serious adverse events. Those numbers are the dream.
As a Hannukah gift to you today, we have given you a little flashlight for your keychain. When you look at it or use it in a tight spot where you have trouble seeing something important, we hope you will remember the power of light. We hope you remember your role in the Leapfrog experiment.
Now I’m going to take you to a dark place, and then bring you back to light.
I’m going to take us back 113 years to 1912. In that year you may not know:
- William Howard Taft was president
- Juliette Gordon Low founded the Girl Scouts.
- Arizona was admitted to the union.
- The Oreo was invented.
And in that year, on April 10th, a new ship began its maiden voyage from Southampton, England.
It never arrived at its destination in New York City.
Okay, some of you are cringing.Tell me Leah is not about to compare the U.S. health care system to the doomed Titanic.
Well not quite. But stay with me, this is a dark part, there will be light.
Many of us don’t know much about 1912 but we remember the Titanic.
It’s not the movie—there were many movies. The question is why it was the subject of movies. The story of what happened is so powerful.
I think there’s three main reasons it’s so memorable.
First of course the human tragedy.
There were about 2200 people on board
1500 of them died in 28 degree water, which would have felt like being stabbed. Most had been warm in their bed only a couple hours earlier, and now this.
712 of the passengers survived, but the survivors had their lives torn apart.
The survivors bore witness. The haunting death cries of 1500 people. The disappearance of the great ship beneath the otherwise quiet sea. The cold moonless dark night.
The string orchestra was playing the hymn Nearer my God to Thee, and some survivors recall people dying in the water singing the words:
"Though, like a wanderer,
The sun gone down,
Darkness comes over me,
My rest a stone;
Yet in my dreams I’d be
Nearer, my God, to Thee."
The second reason we remember the Titanic was because it was, well, a Titanic example of human genius and innovation. It was a dazzling, state of the art for 1912. And it was big!
It cost $7.5 million to build--$250 million today.
It was 18 stories high and 4 city blocks long.
Picture four of the Gaylord Atriums.
It had a famous gold staircase.
They advertised it as virtually unsinkable.
And the whole thing sank like a stone in under 3 hours.
Mother Nature one, Human genius, zero.
Which brings me to the third reason we remember the Titanic. For as much as it was an edifice to human genius, the tragedy was also an edifice to human stupidity. But since mistakes and bad judgement and baffling bad decisions happen at all IQ levels, stupidity just isn’t the right word. I’ll call it folly, the word Pulitzer prizewinner historian Barbara Tuckman used in her landmark book “the March of Folly.”
I say Folly because as it turns out: The whole tragedy could have prevented.
All or at least a lot of lives could have been saved, but for some unbelievably stupid mistakes—unbelievable folly.
For instance:
A ship, the Californian, was nearby and could have come to the rescue, but the sole Marconi telegraph operator was off duty and asleep.
Another ship heard distress signals but misinterpreted them as some kind of promotion for the shipbuilder,at 2 o’clock in the morning. This made no sense in hindsight but that’s truly what happened.
The titanic had enough lifeboats for only about half the passengers, because the shipbuilder, Bruce Ismay, who himself escaped on one of the lifeboats, thought they didn’t look aesthetically pleasing tied up to the side of the ship. They were ugly.
The crew had not drilled the procedures for using the lifeboats. They aren’t easy to maneuver. They are heavy and have to be lowered hundreds of feet in unison by several strong crew members. Plus you have to load them with scared people very quickly.
As a result, much of the already limited lifeboat capacity was not used.
And then there was the one simplest thing of all, that might have prevented every death..
The lookouts didn’t have binoculars.
They were locked in a drawer and the key was missing.
Nobody thought it was important enough maybe take an axe to the drawer?
It was a moonless night, with very clear stars that created a mirror affect on the water. This is beautiful, but also makes it very hard to see shapes like, say, icebergs in the water.
So the Titanic disaster is remembered because of the extremes it revealed of human genius and human folly. And the terrible suffering that resulted.
Now let’s turn to the U.S. health care system.
Here too we see the extremes of human ingenuity and human folly, and yes, sadly, too much preventable death and suffering.
And for some patients, there comes a time as terrifying and preventable as Titanic passengers endured 113 years ago.
And in health care, we lose the equivalent of ten Titanics a month to errors, accidents, injuries and infections in hospitals.
No patient should ever be doomed to that end.
The human folly that made the Titanic disaster possible was all perfectly legal.
Ships didn’t have to have 24-7 coverage on the Marconi. It wasn’t required to have enough lifeboats for all the people on board. Crews didn’t have to be trained or drilled for emergencies. Nobody required use of binoculars.
The legal and regulatory standard always tends to be a lower standard.
But people in 1912 probably didn’t want to be on a ship without enough lifeboats had they known.
Which is why Leapfrog wanted a higher standard of safety and quality and we felt the passengers of our health care system deserved to know.
We wanted to know about the lifeboats, the equipment, the crew of health care. Do you save patients from mistakes, do you have enough trained clinicians, does your technology work to the benefit of patients?
Let’s think for a minute how a Leapfrog standard might have come into play before the Titanic set out on its maiden voyage.
Maybe we would have sent a survey to shipbuilders asking them to voluntarily tell us, so we could publish answers to questions like
How often do you drill on the use of lifeboats
What is the capacity of your lifeboats?
How many lookouts are on duty? Are they equipped properly?
Do you have 24-7 coverage in the telegraph office?
Then Leapfrog would rate ships on safety, based on lifeboats, equipment, and crew.
Likely some shipping companies would say they don’t have time to count lifeboats they are busy, and besides they meet all regulatory standards.
With the Leapfrog Ship Safety Grades published in the newspaper, maybe some potential passengers might have canceled their trip on the Titanic. Maybe Bruce Ismay would decide a few more ugly lifeboats is better than a publicly reported bad grade.
Of course this hypothetical from 1912 is not so hypothetical in the health care industry of today. And fundamentally the Leapfrog surveys are asking about the lifeboats, equipment, and crew of every hospital and every ASC in America.
Then came Leapfrog’s tenth anniversary, also the tenth anniversary of the publishing of To Err is Human. The IOM’s landmark report on patient safety.
At that anniversary, a series of studies asked if things got better. The answer: no change. It got worse.
The Leapfrog Board under Dave Knowlton’s leadership asked: it our experiment a failure?
Answer: not necessarily. The problem is that hospitals can opt out of being transparent by declining to report to the Leapfrog Survey.
So we started the Leapfrog Hospital Safety Grade.
The idea: restaurant grades for hygiene in LA and then NY.
But still didn’t know what we wanted to know about lifeboats, equipment, and crew.
So we kept using the Leapfrog Hospital Survey data when we had it.
Then certain things started to happen.
First, hospitals started touting their As to their community and to their staff
Second, members of the C-suite started to have part of their compensation tied to Hospital safety grades. Over 65% now report doing that.
Third, hospitals started talking openly about patient safety.
Fourth, members of the public started talking about safety and the grade online and in other forums.
Boards started asking questions about patient safety.
The media started covering every six months the release of new Safety Grades.
The impact has been seismic.
A study in JAMA found very in the past decade significant improvements on patient safety measures on everything CMS and Leapfrog measure. It was a 20 and 30 percent improvement for virtually every measure. This is very significant because in my career there has been no movement in patient safety.
The American Hospital Association and Vizient also issued a new report repeating the message from last year’s similar report: patient safety is improving.
When Leapfrog publicly reports a measure, either through the Hospital Safety Grade or the Hospital Survey, the measure moves in the right direction.
That means it improves, and that means saved lives. Fewer infections, fewer adverse events. We see the passengers of many Titanics saved.
But transparency still has its opponents.
In the old days hospitals would respond to bad grades by pointing a finger at Leapfrog. That whole Grade is wrong. And they would tell falsehoods, hospitals can pay to get an A.
Old arguments we have to tamp down with simple facts.
Selling consulting services—we don’t advise hospitals on how to be safer.We don’t sell consulting at all.
Automatically give a D or an F if we don’t like you or to punish you for not submitting the Survey. We aren’t out to punish anyone, we are out to use the best publicly available data in the most responsible way possible. Lots of hospitals decline to participate in the Survey and still earn As, Bs, and Cs.
One hospital accused us of hacking their computer system to get the patient safety data we download from CMS. In the early days of the Safety Grade, many hospitals had no idea CMS was collecting this data and couldn’t imagine it would ever be made public.
Another system CEO with a bad grade said that the grade must be wrong because all of these fine hospitals got bad grades just like his hospital. Then he listed those other fine hospitals, which generated lots of continuing media coverage for those other hospitals too. I’m sure they appreciated.
Then over time we saw a major shift in how hospitals react to bad Grades.
From criticizing the grader to reassuring the public they serve that they actually put patients first. (And yes, they still criticized the grader). We don’t care about criticism it makes us better. We do care about hospital leaders committing to their community that they will put patients first.
Today we have a lawsuit brought by five hospitals in south Florida’s Palm Beach area, all owned by Tenet Healthcare. In the most recent Fall grades, those five hospitals earned Ds and Fs.
With this lawsuit, which we will win, we are traveling down memory lane, to those old tired arguments.
A COO of one of the hospitals published an op ed which accused Leapfrog of various nefarious motives, all false. But not one word offered proof Leapfrog was wrong and her hospitals are doing a good job, or reassurance at least that they put their patients first.
We did a counter op-ed that focused on the proof of their track record. Since they disagree with our methodology, we pointed out that CMS gives all five hospitals just one or two stars, and Mayo Clinic’s new ratings program gives all five exceptionally low scores, including one of their hospitals the lowest possible score in the country.
We would like these hospitals to participate in the Leapfrog Hospital Survey because it is the gold standard of hospital transparency, the highest standard of excellence. But if they don’t, they could still earn an A if they did well on CMS. They do not.
These hospitals have spent millions of dollars to try to get Leapfrog to hide their grades from public view. That’s what they are asking for in this lawsuit. And that’s the one thing we will never do. Because transparency, light, is our mission and purpose.
But here’s a message to these five hospitals and their parent Tenet: Leapfrog fought for 25 years for the transparency we have today. And we aren’t going back.
We aren’t going back to a time not that long ago when hospitals were allowed to hide their medical errors from the public they serve.
That’s the darkness part of my remarks today. Now for the light.
In our next 25 years, Leapfrog has a bold agenda. We will embrace the possibilities of AI, patient-reported quality measures, an end to fee for service payment, and expanding transparency in more settings than hospitals and ASCs. We will prevent more suffering.
We will work to make sure transparency about price is paired with transparency about quality. Price transparency is a hallmark of this Administration’s health care agenda and has bipartisan appeal. But there is no good price for bad care. So quality should always be accounted for.
And here’s my message to you in this room, our supporters, employers, business coalition leaders, patient activists, Top Hospitals and Top ASCs.
YOU are the reason transparency leads to saved lives.
You are the pioneers of transparency. You do not seek to shield yourself from the light/ light. You make use of it.
Leapfrog needs you to stand by our side, to stand up for the Leapfrog experiment. To tell your story of why you are part of Leapfrog.
Especially for hospital leaders in this room who have accomplished so much. You meet Leapfrog standards for excellence and embrace transparency, as tough as it is and it is tough. We need you to lead your industry away from the last gasps of old ways of old thinking.
So please, speak up when you can. Silence is a form of darkness.
Together all of us are inspiring a new generation of health care. We are preventing the Titanic tragedies and the folly that causes them. We are going to embrace instead the extraordinary genius and compassion of health care in America.
And we are not going to let darkness win over light.
Could we lower the lights in this room.
Please shine your little light on the ceiling. Not in each other’s eyes!
Let’s think of each pinpoint of light as a life each of you will save with your fearless commitment to transparency and excellence.
Here is a Jewish prayer of light in the darkness:
Teach us to be bearers of light for one another,
To kindle hope where despair has taken root,
And to remember that even the smallest flame
Can pierce the deepest night.
Bless us with courage,
Wrap us in peace,
And let Your light never fade from our hearts.