1 – Is Leapfrog’s grading system a fair representation of health care safety? Why or why not?

Yes. The Leapfrog Hospital Safety Grade is the nation’s only rating focused entirely on patient
safety—preventable errors, accidents, injuries and infections. The methodology was developed
by an Expert Panel of the country’s foremost experts in patient safety and has been peer-
reviewed and published in the Journal of Patient Safety. Data used to calculate the grades
comes from validated and publicly available data sources. The Leapfrog Hospital Safety Grade is
updated twice annually – each spring and fall – with the latest possible data to accurately
identify hospitals that improve, as well as those that lapse, over the course of the year.

2- Should patients use this to make informed health decisions over other systems like IBM Watson
Health which ranked some hospitals higher than Leapfrog did?
Hospitals are complicated places and patients have a lot at stake when they choose one, so we
think it’s valuable to have many voices to advise consumers on the performance of hospitals.
But safety should be the first consideration, because the quality of the surgery, technology or
expertise of the staff won’t matter if the patient suffers an infection, accidentally gets the wrong
medication or suffers a wrong site surgery. The Leapfrog Hospital Safety Grade is the only rating
that focuses exclusively on errors, accidents and injuries. After a consumer is satisfied with the
safety of the facility, we encourage them to research other information about quality before
making a decision. Because each ratings system assesses different components of hospital
performance it is expected that different ratings would come to different conclusions. Patients
should use this information and speak with their doctor to determine what factors are most
important to their care in addition to safety in order to make decisions on where to seek care.

3 – How is there discrepancy between these two?

The Leapfrog Hospital Safety Grade includes measures reported by the federal government via
the Centers for Medicare & Medicaid Services (CMS), measures reported on the annual Leapfrog
Hospital Survey and secondary data sources. These measures are in two domains:
Process/Structural and Outcomes.

Outcomes measures include:

 Five infections, including central line-associated bloodstream infections, catheter-
associated urinary tract infections, surgical site infections for colon surgeries, MRSA and
C.diff
 Falls and trauma, as well as very severe pressure ulcers
 Preventable complications from surgery such as foreign objects retained in the body,
post-operative hazards and accidental punctures or lacerations

Process/structural measures credit hospitals for having the procedures and protocols known to
prevent infections, errors and accidents, such as:
 Strong nursing leadership and engagement
 Use of Computerized physician order entry systems and bar code medication
administration to prevent medication errors
 Hand hygiene policies
 The right staffing for ICUs
 Patient-reported experience measures that are known from studies to correlate with
patient safety
 IBM Watson uses different sources of data to calculate their hospital ratings including Medicare
Provider Analysis and Review (MEDPAR) and Medicare Hospital Cost Report Information System
(HCRIS).

4 – Some Hospital systems have told us they participated in this survey because by participating it was
possible their score would increase. Is that in any way pressuring hospitals to participate and does it
change the score?
The Leapfrog Hospital Survey is one source of data for the Leapfrog Hospital Safety Grade, but
hospitals do not have to participate in the Survey to receive a grade. Participation in The
Leapfrog Hospital Survey gives hospitals the opportunity to report additional information about
their safety measures. If a hospital performs well on certain measures on The Leapfrog Hospital
Survey, they have the opportunity to earn more points in their Hospital Safety Grade for those
measures. This is because the data hospitals report to Leapfrog is much more comprehensive
than data available from other publicly available sources. However, participation alone is not a
guarantee of a better grade: if a hospital is not performing well on safety metrics that are
evaluated through the Survey and included in the Safety Grade, their Safety Grade will not be
better solely based on the fact that they participated. Hospitals that participated in the 2019
Survey have received all grades, A – F, and likewise hospitals that did not participate in the 2019
Survey but still received a grade received all grades, A – F.

5 – I’m told your survey is “process based” versus “outcome based” – What does this mean for
patients and why is the difference important?
The Leapfrog Hospital Safety Grade is comprised of up to 28 measures of patient safety divided
into two domains: Process/Structural Measures and Outcome Measures. Each domain
represents 50% of the Leapfrog Hospital Safety Grade.
Patients should consult the Safety Grades and try to find the highest graded hospital for their
care. www.HospitalSafetyGrade.org, which is completely free to the public, allows patients to
drill down into the measures that comprise a hospital’s grade and see both how well they are
doing on the processes hospitals should have in place to prevent errors, as well as the rate with
which errors have actually occurred in the hospital. Both factors are important considerations
for patients.