My Hospital Got an “A”, Can It Get Better?

Maya Ber Lerner
4 min readJul 1, 2021

If you ride the New York Metro-North Harlem line from Grand Central station these days, you will see the NYU Langone Health signs flaunting the hospital’s “A” rating for patient safety dominating the station billboards. This is great. Not just because NYU Langone Health happens to be my hospital, but also because this kind of investment in advertising the hospital’s safety grade means that it’s on the agenda.

Image from

Grading hospitals, just like restaurants

In the powerful 2019 documentary “To Err is Human”, Leah binder, the president and CEO of The Leapfrog Group, talks about her vision of hospitals putting their safety letter grade in their front window, like restaurants in New York City. Would you step into a restaurant that has an “F” on its window?


The Leapfrog Group is a non profit that has been around for 20 years. It created a hospital safety grade of “A” to “F” to rate how well US hospitals protect patients from errors, accidents, injuries and infections. Over 2,700 hospitals are issued a safety grade twice every year.

According to The Leapfrog Group:

Upwards of 250,000 people die every year from hospital errors, injuries, accidents, and infections

Every year, 1 out of every 25 patients develops an infection while in the hospital — an infection that didn’t have to happen.

A Medicare patient has a 1 in 4 chance of experiencing injury, harm or death when admitted to a hospital

Today alone, more than 1000 people will die because of a preventable hospital error

Understanding the Leapfrog rating

The rating for a hospital shows the hospital’s score based on a set of outcome and process measures.

Outcome measures are based on errors, accidents, and injuries that this hospital has publicly reported.

You can’t really argue with the outcome measures. It’s hard numbers, of deaths and infections and complications. Incidents like forgetting sponges and needles in patients bodies, death from treatable serious complications and MRSA infections either happen or don’t (btw, the latter used to be viewed as unavoidable, but as you can see in the table below — the best performing hospitals get it to 0).

Outcome measures. MRSA infection is 0.000 at best performing hospitals (

The problem with these outcome numbers is that measuring them is not enough if you want to show improvement. This is why process measures make up 50% of the score.

Process measures include the management structures and procedures a hospital has in place to protect patients from errors, accidents, and injuries. These measures are a bit more challenging. They are not the actual safety achievement but rather an indication that the hospital is making an effort to improve. They reflect the errors that don’t happen.

50% of the process measures are about communication.

The connection between communication, quality and safety is an important one. Numerous studies have shown that communication is pivotal to patient safety.

According to the Joint Commission’s (TJC’s) Sentinel Event Database, communication was identified as a leading root cause of sentinel events in the United States. It is progressively recognized that poor communication is a major factor in health care errors and remains a serious challenge to overcome in health care.

Enhancing Communication to Improve Patient Safety and to Increase Patient Satisfaction” (Healthcare Management Journal 2017)

How to improve and measure communication?

Some communication measures are based on patients’ assessment: how their doctors and nurses communicated with them, the responsiveness of the hospital staff, the information they received about medicines and discharge. Given a large number of patient reviews, you can get a picture of the state of a hospital.

The “Staff work together to prevent errors” measure is tricky. The explanation on the website says it is based on a “strong culture of safety” which safe hospitals achieve by “regularly surveying their physicians, nurses, and other staff on the culture of safety to measure how well staff works together to keep patients safe. Then, hospitals provide feedback on the results to leaders and hospital staff and create plans to improve.”.

The “Staff work together to prevent errors” measure (

This is a start, but the critical communication measures need to get more attention. It is possible to increase communication, structure it, and assure that it happens — within care teams, as well as with patients.

The future of patient safety is outstanding communication

The best performing hospitals will raise the bar and create higher standards when it comes to care-team communication and patient communication. The next generation of “A”s is game-changer-hospitals that figure out how to take communication to the next level, where it is more than surveys and protocols.

Other links: