Medical errors
Does a hospital safety grade actually predict whether you survive, or is it a paperwork score?
Hospital-acquired infections have mostly fallen well below their 2015 baseline, but two measures remain above it (abdominal hysterectomy surgical-site infections and ventilator-associated events), and Leapfrog A grades sat in a flat 29 to 34 percent band for eight years before a Spring 2026 jump that a methodology change partly explains.
The problem
Patient safety remains a national hospital-performance problem because preventable harm varies by facility and service line while accountability systems often diffuse responsibility. Infection control, safety grades, and penalty programs show that the sector has measurable signals, but they are not always tied to a disciplined improvement operating model.
The recommendation
Run safety improvement as a facility-level performance turnaround program. The recommended approach is to prioritize low-performing hospitals and worsening infection types, align penalties with harm reduction, and require transparent measurement that connects safety grades to patient outcomes.
How safe is the stay?
The grade the typical hospital earns, whether it is improving, and which harms are winning or losing.
Leapfrog hospital safety grades, Spring 2026
Share of the 2,363 graded general acute-care hospitals at each letter grade, the most recent Spring 2026 cycle.
Read it this way The 27 percent of hospitals at a C, plus the 2.5 percent at D or F, sit below the 39 percent that earn an A, the first cycle in which A is the single largest grade. Read the A-share against the caveat: Spring 2026 is also the first cycle to hold 450 non-participating hospitals out as Grade Not Assigned, which shrinks the graded pool and lifts every grade share, so this is not cleanly comparable to earlier cycles. Use this chart to identify the safety signal being measured and why the recommendation prioritizes facility-level improvement, infection control, and outcome-linked accountability.
Caveat Spring 2026 excluded 450 hospitals that did not participate in the 2024 or 2025 Leapfrog survey (Grade Not Assigned), a new category. Shares here are of the 2,363 hospitals actually graded, so the jump in the A-share versus earlier cycles partly reflects this denominator change, not only real improvement. Separately, the avoidable-death and 160,000-deaths estimates tied to these grades (see the risk chart) are contested modeled figures disputed in the patient-safety literature, not a single settled number.
⊞ data table⬇ CSV
| Safety grade | Share of graded hospitals (percent) |
|---|---|
| A | 38.8 |
| B | 31.3 |
| C | 27.3 |
| D | 2.3 |
| F | 0.2 |
Leapfrog Hospital Safety Grade, Spring 2026 · Spring 2026 · source
Leapfrog safety-grade shares by cycle, Spring 2018 to Spring 2026
Percent of graded hospitals at each letter grade, every cycle. Use the Grade picker to isolate one line. The A-share held a flat 29 to 34 percent band for eight years before the Spring 2026 jump.
Read it this way For eight years no grade share moved much: A stayed in a 29 to 34 percent band and C led the field. Spring 2026 breaks that pattern, with A rising to 39 percent and C and D falling sharply, but the caveat matters: that cycle first excluded 450 non-participating hospitals as Grade Not Assigned, which mechanically lifts every remaining share. Treat Spring 2026 as a possible turn, not yet confirmed real improvement. Use this chart to identify the safety signal being measured and why the recommendation prioritizes facility-level improvement, infection control, and outcome-linked accountability.
Caveat Each point is the share of hospitals graded that cycle (Leapfrog grades twice a year). Spring 2026 is the first cycle to exclude 450 non-participating hospitals as Grade Not Assigned. Because those hospitals leave the graded denominator, the Spring 2026 rise in A and drop in C, D, and F partly reflect the denominator change rather than only genuine improvement.
⊞ data table⬇ CSV
| Cycle | A | B | C | D | F |
|---|---|---|---|---|---|
| Spring 2018 | 30.3 | 27.6 | 35.5 | 5.8 | 0.9 |
| Fall 2018 | 32.3 | 24.1 | 36.8 | 6.2 | 0.6 |
| Spring 2019 | 31.8 | 26 | 35.8 | 6.1 | 0.3 |
| Fall 2019 | 33.3 | 24.8 | 34 | 7.5 | 0.3 |
| Spring 2020 | 33.1 | 25.2 | 34.5 | 6.7 | 0.5 |
| Fall 2020 | 34.1 | 24.1 | 34.7 | 6.5 | 0.6 |
| Spring 2021 | 33.1 | 24.1 | 35.4 | 7 | 0.4 |
| Fall 2021 | 32 | 26.1 | 34.7 | 6.5 | 0.7 |
| Spring 2022 | 32.8 | 23.9 | 35.9 | 6.8 | 0.6 |
| Fall 2022 | 29.5 | 27.5 | 36.1 | 6.4 | 0.5 |
| Spring 2023 | 29.1 | 25.9 | 38.6 | 6 | 0.4 |
| Fall 2023 | 29.6 | 24.1 | 39.3 | 6.6 | 0.4 |
| Spring 2024 | 29.1 | 25.9 | 37.2 | 7.4 | 0.4 |
| Fall 2024 | 32.1 | 24.2 | 36.2 | 7 | 0.5 |
| Spring 2025 | 32.1 | 24.4 | 35.4 | 7.4 | 0.7 |
| Fall 2025 | 31.9 | 26.1 | 33.2 | 8 | 0.8 |
| Spring 2026 (excl. GNA) | 38.8 | 31.3 | 27.3 | 2.3 | 0.2 |
Leapfrog Hospital Safety Grade, cycle Explanation-of-Safety-Grades files · Spring 2026 · source
Hospital infection rates since the 2015 baseline
Each line is a standardized infection ratio (SIR). A value of 1.0 equals the 2015 national baseline. Below 1.0 is better than baseline. Use the Infection measure picker to isolate one line.
Read it this way Five of the seven lines trend well below the 1.0 baseline, led by C. difficile at 0.375. Two remain above it in 2024: SSI hysterectomy, which reversed after 2019 and climbed to 1.112, and ventilator-associated events (VAE), which spiked to 1.461 in the 2021 COVID surge and has fallen back to 1.105 but is still above baseline. The 2020 to 2021 bumps across most lines line up with the noted COVID-19 disruption, so read that stretch as a pandemic-driven anomaly rather than a change in underlying practice. Use this chart to identify the safety signal being measured and why the recommendation prioritizes facility-level improvement, infection control, and outcome-linked accountability.
Caveat MRSA and C. difficile entered CMS scoring in FY2017. VAE annual SIRs are from the CDC AR&PS data portal (the progress-report page shows VAE only as a year-over-year percent change). All series use the 2015 national baseline and are shown from 2015 = 1.0 for comparability. The 2020 and 2021 spikes reflect COVID-19 disruption.
⊞ data table⬇ CSV
| Year | CLABSI | CAUTI | MRSA | C. difficile | SSI colon | SSI hysterectomy | VAE |
|---|---|---|---|---|---|---|---|
| 2015 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| 2016 | 0.891 | 0.93 | 0.935 | 0.921 | 0.933 | 0.874 | 0.98 |
| 2017 | 0.814 | 0.88 | 0.862 | 0.804 | 0.906 | 0.89 | 0.952 |
| 2018 | 0.739 | 0.809 | 0.84 | 0.711 | 0.887 | 0.938 | 0.947 |
| 2019 | 0.689 | 0.741 | 0.817 | 0.583 | 0.855 | 0.979 | 0.967 |
| 2020 | 0.857 | 0.754 | 0.941 | 0.518 | 0.81 | 0.892 | 1.301 |
| 2021 | 0.921 | 0.795 | 1.07 | 0.501 | 0.831 | 0.993 | 1.461 |
| 2022 | 0.836 | 0.697 | 0.904 | 0.484 | 0.858 | 0.951 | 1.188 |
| 2023 | 0.724 | 0.621 | 0.755 | 0.42 | 0.879 | 1.031 | 1.131 |
| 2024 | 0.66 | 0.559 | 0.703 | 0.375 | 0.845 | 1.112 | 1.105 |
CDC NHSN Annual SIR, Acute Care Hospitals · 2024 · source
Infection rates by type, 2024
Standardized infection ratio in 2024. A value of 1.0 is the 2015 baseline. Two measures sit above it: abdominal hysterectomy surgical-site infection and ventilator-associated events.
Read it this way Two bars cross the 1.0 reference line: SSI hysterectomy at 1.112 and ventilator-associated events (VAE) at 1.105, while every other type sits below baseline, led by C. difficile at 0.375. This single-year snapshot shows which measures are currently worst. The trend chart alongside it shows that hysterectomy infections drifted above baseline over time while VAE spiked during COVID and is now falling back. Use this chart to identify the safety signal being measured and why the recommendation prioritizes facility-level improvement, infection control, and outcome-linked accountability.
⊞ data table⬇ CSV
| Infection type | 2024 standardized infection ratio |
|---|---|
| SSI hysterectomy | 1.112 |
| VAE | 1.105 |
| SSI colon | 0.845 |
| MRSA | 0.703 |
| CLABSI | 0.66 |
| CAUTI | 0.559 |
| C. difficile | 0.375 |
CDC NHSN Annual SIR, Acute Care Hospitals · 2024 · source
Does it matter, and does the system respond?
Whether the grade predicts survival, and whether Medicare's penalties bite the worst hospitals or just punish a fixed share every year.
Avoidable-death risk by safety grade, relative to A hospitals
Percent greater avoidable-death risk versus an A hospital. A hospitals are the zero-percent baseline. The gradient is monotone from B to D or F.
Read it this way The jump from B at 35 percent to C at 88 percent is much larger than the step from C to D or F at 92 percent, so the modeled risk increase is concentrated between B and C grades, not spread evenly. Because these are the same contested Leapfrog and Johns Hopkins figures flagged in the caveat, treat the ordering as more reliable than the exact percentages. Use this chart to identify the safety signal being measured and why the recommendation prioritizes facility-level improvement, infection control, and outcome-linked accountability.
Caveat These are contested, modeled Leapfrog and Johns Hopkins figures, not a settled number, and should be read alongside competing patient-safety estimates.
⊞ data table⬇ CSV
| Safety grade | Greater avoidable-death risk vs an A hospital (percent) |
|---|---|
| B | 35 |
| C | 88 |
| D or F | 92 |
Leapfrog and Johns Hopkins Armstrong Institute, Lives Lost Lives Saved · 2019 · source
Who falls behind
The safety gap is not uniform. It varies by hospital ownership and by state.
Why this matters
Medicare's own penalty programs are built on relative cutoffs, the top quartile for infections and the peer-group median for readmissions, not absolute improvement thresholds, so the share of hospitals penalized stays fixed near 78 to 83 percent for readmissions and about 25 percent for infections regardless of whether hospitals actually get safer. Against that flat backdrop, five of seven tracked infection types have fallen well below their 2015 baseline, C. difficile down 62.5 percent and CLABSI down 34 percent, showing the underlying tools do work. Two measures are the exception: surgical-site infection after abdominal hysterectomy reversed after 2019 and is now 11.2 percent above baseline and still climbing, and ventilator-associated events remain 10.5 percent above baseline after a COVID-era spike.
Recommended actions
- Target infection-prevention resources specifically at surgical-site infection after abdominal hysterectomy and at ventilator-associated events, the two measures still above baseline, rather than treating all hospital-acquired infections as one improving trend.
- Watch the A-grade share, which held a flat 29 to 34 percent band for eight years. The Spring 2026 jump to 39 percent coincides with a new exclusion of 450 non-participating hospitals, so confirm it repeats in a like-for-like cycle before calling it real improvement.
- Flag government-owned hospitals for targeted safety-improvement support given the near two-to-one gap against nonprofits (17 percent versus 33 percent earning an A).
- Track the four zero-A states for state-level intervention and watch whether the relative-cutoff penalty designs are driving real improvement or simply reallocating a fixed penalty share each year.
- Treat the 160,000-avoidable-deaths and grade-based mortality-risk figures as directional only, since they are contested modeled estimates disputed in the patient-safety literature.
The recommendation
Therefore, run safety improvement as a facility-level performance turnaround program. The recommended approach is to prioritize low-performing hospitals and worsening infection types, align penalties with harm reduction, and require transparent measurement that connects safety grades to patient outcomes.
Demographic slice none. AHRQ/CMS HAC/Leapfrog data is hospital-level, not patient-demographic-level.
Sources
- CMS Hospital-Acquired Condition Reduction Program, Provider Data Catalog · FY2026
- CDC NHSN Annual SIR, Acute Care Hospitals · 2024
- Leapfrog Hospital Safety Grade, Spring 2024 · Spring 2024
- Leapfrog Hospital Safety Grade, state rankings · 2024
- Leapfrog and Johns Hopkins Armstrong Institute, Lives Lost Lives Saved · 2019
- CMS Hospital Readmissions Reduction Program Dataset · FY2024
- KFF, 10 Years of Hospital Readmissions Penalties · 2021