Valley Children's Case Study

Each year, there are roughly six million hospital stays for children in the United States. When children need care in a hospital, it is a stressful experience for both the patient and their parent or caregiver. Given the lack of publicly available data about the quality of inpatient pediatric care, parents often have little information on which to choose a hospital for their child’s care. To give parents more information to make these critical decisions, Leapfrog asks pediatric hospitals to participate in the annual Leapfrog Hospital Survey, which collects data on safety and quality, and then publishes the results by hospital.

The highest performing hospitals on the Leapfrog Hospital Survey are recognized annually with the prestigious Leapfrog Top Hospital Award including the Top Children’s Hospital Award. Top Hospitals have better systems in place to prevent medication errors and lower infection rates, among other laudable qualities.

Valley Children’s Hospital’s Journey to Achieving Leapfrog’s Top Children’s Hospital Award

Valley Children's Hospital, formerly Children's Hospital Central California, is a stand-alone, pediatric acute care children's teaching hospital located in Madera County, California. The hospital has 358 pediatric beds and is affiliated with the Stanford University School of Medicine. Valley Children’s has been participating in the Leapfrog Hospital Survey since 2014. They have achieved the Leapfrog Top Children’s Hospital Award three times: in 2019, 2020, and 2022.

In the following interview, Leapfrog President and CEO Leah Binder has a discussion with Raed Khoury, Vice President of Quality and Patient Safety and Clinical Value at Valley Children's Healthcare. The full interview can be seen in the video below which is followed by a written edited excerpt.

Leah Binder: Leapfrog’s Top Hospital Award is an elite award and a very difficult award to achieve. It represents the best of the best in quality and safety among the participants in the Leapfrog Hospital Survey. Today we're going to learn more about the improvements that Valley Children's Hospital has seen in their own quality and safety as a result of Leapfrog Hospital Survey participation.

Raed Khoury: Thank you very much, Leah. I appreciate the discussion this morning, and the collaboration with Leapfrog. Our journey really began with our mission when Valley Children’s was founded 70 years ago, which is to provide high quality, comprehensive health care services to children, regardless of their ability to pay. To support this mission, our vision is to provide the nation's best health care for kids and become the nation's best children's hospital. With this mission and vision, we set goals for ourselves to be the best in quality and to invest in access, efficiency, customer experience, and philanthropic causes. Leapfrog’s standards have helped support and guide our journey.

Leah Binder: Can you give us some examples of measures within the Leapfrog Hospital Survey that have been particularly important to you?

Raed Khoury: First and foremost, the safety measures. Because there are six pillars of quality, but safety is the one that's really most visible. Central line infections, urinary tract infections from catheters, C.diff., and all the health care-associated infections, contribute to longer patient stays and more cost. These infections are critical to eliminate completely as well as eliminating preventable harm as a whole. Patients should never get an infection when they come to the hospital.

Leah Binder: How did reporting to the Leapfrog Hospital Survey help you in this? Did the Survey help you to identify areas where you needed improvement?

Raed Khoury: Any time we engage and report our progress in quality and safety, we become better because it allows us to self-examine. It also allows us to look at best practices and collaborate with other hospitals. The first thing I do is look at who else in our region is a Top Hospital and try to communicate with my peers to share and learn best practices. I think collaboration and networking allows us to get familiar with other Top Children’s Hospitals and helps us improve together.

"We will never compete on safety or quality. We will teach and we will learn from our colleagues so we can all improve together."

Leah Binder: Yes, best practice sharing is very valuable and important. I assume you're open to anyone from a children's hospital who is reading or watching this case study reaching out to you?

Raed Khoury: Absolutely. As you know, one of the collaboratives that we are also involved in is the Solutions for Patient Safety and almost all pediatric hospitals are involved in it. We will never compete on safety or quality. We will teach and we will learn from our colleagues so we can all improve together. That’s what’s unique about children’s hospitals.

Leah Binder: That’s wonderful to hear. Children come first. How did you persuade others in your hospital that it’s important to participate in the Leapfrog Hospital Survey such as other leadership and your board?

Raed Khoury: Well, obviously, the involvement of the board and senior leadership is critical in the success of any initiative and our board and senior leadership are very involved in quality and patient safety. They all have received formal training on quality and patient safety and these issues are one of the top agenda items in every meeting we have, so it really didn't take any convincing. They are directing the ship, and where we need to be in terms of quality and patient safety for Valley Children’s, so I had a very easy job and they’ve always been supportive of Leapfrog involvement.

Leah Binder: Well, that's heartening to hear. Did you hear any concern about the transparency of the Leapfrog Hospital Survey results?

Raed Khoury: In our industry there are often concerns about lawsuits or things like that, but we really have demonstrated that by being transparent, we get better. It takes a while, as with everything else, and culture takes time to change. But in the end, transparency will help the organizations get better, and will help all of us get to a place where we eliminate harm. If we don't show where we are at, how are we going to improve?

"Transparency is the foundation of trust and how you get better is by talking about it. We're here to learn, teach, and improve."

Leah Binder: Transparency is extremely important to us. It is the indispensable first step in a journey toward saving lives. As humans, we don't always like it. It feels uncomfortable sometimes, but it can really make a difference. I'm glad to hear that it has made a difference for you.

Raed Khoury: Transparency is the foundation of trust and how you get better is by talking about it. We're here to learn, teach, and improve. There is a great body of research that has shown it's rarely appropriate to blame an individual when an error occurs. It really is a system issue. Transparency helps us identify potential system issues that we need to address ideally before there is any patient harm. In order for us to improve, we have to shed light on the problems, and for that to happen, we have to be able to transparently discuss our issues to become better. We embraced this a long time ago, and it's really working well for us.

Leah Binder: That's really interesting. You think of transparency as a critical element of a just culture -- and that understanding the systemic issues, and getting away from blaming individuals, leads to improvement.

Raed Khoury: That’s right. And you have to demonstrate this from the highest levels at your organization in order to have it be ingrained in your culture. If we want our staff to tell us when errors or near misses occur, we have to model that way for our teams, because they are the ones that really know where the issues are. We really focus on this to create psychological safety for all where we learn from our mistakes, improve, and become better. When we focus on this, year after year we get better and better and better, and it is just infectious.

Leah Binder: Hospitals are safer for patients and families when you're transparent. It's incredibly reassuring to know that even when the results are not perfect, which they never are for anyone, you still have such a strong commitment to absolute candor.

Raed Khoury: Yes, we do. For many years we have had patients on our committees. This is not something new. We have learned a lot from having a non-health care perspective. There’s a provider's point of view on how to get things and then there’s a completely different point of view of a teacher or a mother of a child. We learned the value of having patient families involved a long time ago and it’s provided us with a lot of very valuable information that’s helped us be better and safer.  

Leah Binder: Do you coach patients and families on how to participate in meetings like that? I've heard that sometimes people feel intimidated if they're not a clinician.

Raed Khoury: We don't coach the patients formally, but we meet with them before the meetings to go over what we're going to talk about. The coaching happens for our team, meaning that the language they use has to be simple enough for a non-health care person to understand. We use a lot of acronyms in health care, and I make sure that the rest of the committee understands that may intimidate a patient or family if they don’t understand or know what it really means to them or their child. So it's more of the teams versus the patient that we coach.

Leah Binder: I love that answer, because you're basically saying that we are the ones that have to be coached.

Raed Khoury: Yes, the patient is at the center of everything we do so we have to be coached to interact in a way that’s productive and meaningful.

Leah Binder: In closing, what advice do you have for other pediatric hospital leaders who are interested in using the Leapfrog Hospital Survey participation as a tool to improve?

Raed Khoury: I think the best quote I have really is your quote, so I’m going to quote you. You said, “It takes leadership, teamwork and absolute dedication to patients to achieve this award,” when talking about the Top Hospital Award. That is the advice that I have for other leaders. I also encourage them to become transparent and to really pursue all of the improvement activities that are available to them. When you pursue improvement and transparency over a specific designation, your team becomes better. It’s about the journey to get to the Top Hospital distinction and it’s an important one. It's not overnight improvement; it takes years and years. But you know, once you get there, you have to keep working every day to keep patients as the first priority. Be patient. Work with your teams and continue with prioritizing excellence because all patients deserve nothing less than excellence. We should not harm patients when they come to the hospital and preventable harm should be something from the past. Our kids should never have to deal with that.

"Continuous improvement is key. We have to be better tomorrow than today. That's the approach we have to take until we eliminate preventable harm."

Leah Binder: Well, it is really encouraging to hear you say that. I say that as a mother who cares deeply about my own children, but also as a citizen who cares about everyone’s children. It’s just exciting to hear of your leadership and your health system’s leadership. It is one of the great privileges of my job that we are able to offer you an award and recognition for that with our Top Hospital designation. It’s also a great privilege of the job that we don't issue the award forever. We issue it for one year, and each year we expect to see you back as I’m sure we will next year.

Raed Khoury: That’s right. Continuous improvement is key. We have to be better tomorrow than today. That's the approach we have to take until we eliminate preventable harm. I’m also in support of that strategy of the award being for just one year, and then we have to continue to improve to even qualify for it again. We hope to give you those milestones, and then celebrate. You really do need to stop and celebrate successes and what you’ve achieved. I am deeply grateful to you for your leadership, and for being part of Leapfrog.

Leah Binder: What a difference it can make when leaders like you are committed to their patients first and foremost.

Raed Khoury: And I thank you as well, Leah, for your leadership and making sure you hold us accountable to those high standards and demand that excellence.

Children’s hospitals interested in connecting with Raed to learn more can email him at

Visit Newsletter