Hospital leaders know that patient safety is both a moral imperative and a public measure of trust. The Leapfrog Hospital Safety Grade—reported twice a year—has become one of the most visible indicators of how well hospitals protect patients from preventable harm.

Behind the familiar A–F letter grade is a structured methodology built on nationally reported safety measures. Understanding what those measures are—and why they matter—can help leaders align improvement efforts, staff engagement, and patient communication.

How the Safety Grade Is Organized

Leapfrog evaluates hospitals using two equally weighted domains, each contributing 50% of the final grade:

1. Process and Structural Measures – What systems and practices the hospital has in place

2. Outcome Measures – What actually happens to patients as a result of care

Together, these domains provide a balanced picture of both prevention and performance.

Domain 1: Process and Structural Measures

What hospitals do to prevent harm

These measures assess whether hospitals have the infrastructure, staffing, and communication practices known to reduce errors and improve safety.

Key areas include:

1. Safe Medication Practices

• Computerized Physician Order Entry (CPOE) to reduce prescribing errors

• Bar Code Medication Administration (BCMA) to ensure the right patient receives the right medication

2. Staffing and Clinical Support

• ICU Physician Staffing to ensure critically ill patients receive expert oversight

• Total Nursing Care Hours per Patient Day, reflecting adequate nursing resources

3. Safety Culture and Leadership

• Leadership structures and systems that prioritize patient safety

• Measurement and feedback on safety culture, including how staff concerns are identified and addressed

4. Infection Prevention Fundamentals

• Hand hygiene practices, a cornerstone of preventing healthcare-associated infections

5. Patient-Centered Communication (HCAHPS Measures)

Leapfrog incorporates several HCAHPS communication measures because clear communication is strongly linked to safer care:

• Nurse communication

• Doctor communication

• Staff responsiveness

• Communication about medicines

• Discharge information

These measures reflect whether patients understand their care, medications, and next steps—critical factors in preventing post-discharge complications.

Domain 2: Outcome Measures

What patients experience

Outcome measures capture actual patient harm events, many of which are considered preventable with strong systems and vigilance.

Key outcomes include:

1. Serious Preventable Events

• Foreign objects retained after surgery

• Air embolism, a rare but life-threatening complication

2. Patient Injuries

• Falls and trauma, particularly those resulting in injury during hospitalization

3. Healthcare-Associated Infections

• Central line–associated bloodstream infections (CLABSI)

• Other serious infections reported to national surveillance systems, such as MRSA and C. difficile

4. Adverse Events Composite (CMS PSI 90)

Leapfrog uses the CMS Patient Safety Indicator (PSI) 90 composite, which combines multiple indicators of hospital-acquired complications, such as:

• Pressure injuries

• Postoperative complications

• Accidental injuries and other adverse events

This composite offers a broad view of how well hospitals prevent harm across different patient populations and care settings.

Why These Measures Matter for Leaders and Staff

The Leapfrog Hospital Safety Grade is more than a score—it reflects:

• Leadership commitment to safety

• Frontline staff engagement

• Reliable systems and clear communication

• Patients’ real experiences and outcomes

Because the grade relies heavily on publicly reported data, it also directly affects:

• Community trust and reputation

• Patient choice

• Board-level accountability

Importantly, many of the measures—especially communication and discharge information—are influenced by every role in the hospital, not just clinical leadership.

The Bottom Line

Leapfrog’s methodology reinforces a critical message:

Safe hospitals pair strong systems with consistent execution and clear communication.

For hospital leaders, understanding these measures helps focus improvement efforts where they matter most—protecting patients, supporting staff, and delivering care that is both high-quality and transparent.