Grading hospital systems: How 10 networks fared in Leapfrog Group safety grades

The Leapfrog Group’s new report cards on patient safety go beyond individual hospitals.

In its new Fall 2025 Hospital Safety Grades, Leapfrog also offers a snapshot of how large health systems fared in protecting patients. It’s the first time the organization has included that perspective in its rankings, which come out twice a year. The group released its fall rankings Thursday morning.

Since most hospitals in the nation are part of a parent health system, the group decided it was time to take a system-wide look at these organizations, says Leah Binder, president and CEO of The Leapfrog Group.

Binder tells Chief Healthcare Executive® that the look at the performance system-wide was driven by the increasing consolidation of hospitals nationwide.

“Are they rallying their hospitals together to see system-wide improvements in safety, or are we not seeing that? We really don't know, but we decided to look at the data as a starting point of the question,” Binder says. “And we are hopeful that people will start this conversation, because the systems are here to stay. Let's make sure that they're delivering the care that we want.”

(See part of our conversation in this video. The story continues below.)

Leapfrog offered details on 10 large hospital systems, and Binder notes variation in the systems.

HCA Healthcare, the nation’s largest hospital system, earned A grades at 51 hospitals, or about a third of HCA’s hospitals. HCA also saw a third of its hospitals get a “C,” which tracks with Leapfrog’s overall rankings. One in three hospitals nationwide received a C in Leapfrog’s fall grades.

HCA had more hospitals with an “A” grade than any hospital, but the system has more hospitals than any other. Other health systems had a higher percentage of A-rated hospitals. CommonSpirit Health had nearly as many hospitals with an A (49) as HCA, despite having fewer hospitals.

Sutter Health (75%), Northwell Health (68%) and AdventHealth (66%) all saw at least two-thirds of their hospitals getting an A in Leapfrog’s report.

Leapfrog also included the Defense Health Agency, which earned high marks. Eighteen of 20 military hospitals (90%) received an A, which Binder called a pleasant surprise.

“They have a very high percentage of ‘A’ hospitals, much higher than the rest of the country. I mean, they’re excelling on safety. So that was very impressive, and kind of a surprise,” Binder says.

Since this is Leapfrog’s inaugural look at health systems, there isn’t a track record for comparison. But health system leaders can take a look at how their grades compare against all hospitals, Binder suggests. Systems with a higher percentage of A-rated hospitals can likely feel good, but those with a higher percentage getting a C have some work to do, she says.

“If your system has a higher rate than 33% getting C's, right away, you know something's not going well in your system,” Binder says. “And we do see lots of variation.”

But Binder says she wants all health systems aiming for top marks.

“I want them all to get all A's, and they're capable of doing that,” she says. “So go forth.”

Distribution of grades

Here are the overall percentages of hospitals in each grade among all the hospitals evaluated by The Leapfrog Group.

A: 32%

B: 26%

C: 33%

D: 8%

F: 1%

How health systems fared

Here is The Leapfrog Group’s assessment of 10 large health systems, the number of hospitals receiving top grades, and the percentage of hospitals that received that grade. The list also includes how many hospitals were evaluated by the group.

HCA Healthcare

Graded hospitals: 163

A: 51 (31%)

B: 57 (35%)

C: 54 (33%)

D: 1 (Under 1%)

CommonSpirit

Graded hospitals: 94

A: 49 (52%)

B: 28 (30%)

C: 16 (17%)

D: 1 (1%)

AdventHealth

Graded hospitals: 44

A: 29 (66%)

B: 9 (20%)

C: 6 (14%)

Kaiser Permanente

Graded hospitals: 51

A: 27 (53%)

B: 18 (35%)

C: 6 (12%)

Advocate Health

Graded hospitals: 46

A: 24 (52%)

B: 13 (28%)

C: 9 (20%)

Prime Healthcare Services

Graded hospitals: 45

A: 24 (53%)

B: 16 (36%)

C: 5 (11%)

Defense Health Agency

Graded hospitals: 20

A: 18 (90%)

B: 1 (5%)

C: 1 (5%)

Lifepoint Health

Graded hospitals: 45

A: 16 (36%)

B: 14 (31%)

C: 15 (33%)

Northwell Health

Graded hospitals: 22

A: 15 (68%)

B: 6 (27%)

C: 1 (5%)

Sutter Health

Graded hospitals: 20

A: 15 (75%)

B: 4 (20%)

C: 1 (5%)