Leapfrog’s Latest Safety Grades Look at Impact of System Affiliation

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With the release today of its fall 2025 Hospital Safety Grades, The Leapfrog Group found that 90% of hospitals with a grade are part of a health system. This was the first time Leapfrog analyzed hospital performance by health system, also finding that 94% of hospitals receiving A grades were affiliated with a system.

“The Leapfrog Group was founded 25 years ago to improve American healthcare through transparency, and the Safety Grade has been a cornerstone of that effort,” said Leah Binder, president and CEO of The Leapfrog Group, in a statement. “As we mark this milestone year, for the first time we’re looking at how consolidation impacts patient safety. We want to understand if system leadership accelerates patient safety or not.”

Leapfrog also found that 95% of the 358 “Straight A” hospitals—those earning an A for more than two years in a row—were part of health systems. All 11 hospitals that have earned an A for every grading round since 2012 are affiliated with systems.

The 10 health systems with the highest total number of A hospitals and Straight A hospitals are:

  • HCA Healthcare (51 A hospitals, 18 Straight A hospitals)
  • CommonSpirit Health (49, 24)
  • AdventHealth (29, 21)
  • Kaiser Permanente (27, 12)
  • AdvocateHealth (24, 1)
  • Prime Healthcare Services (24, 11)
  • Defense Health Agency (18, N/A). Defense Health Agency is N/A for Straight A recognition because it hasn’t been eligible for a Safety Grade for five rounds or more.
  • Lifepoint Health (16, 2)
  • Northwell Health (15, 3)
  • Sutter Health (15, 3)

State rankings

Leapfrog also ranks states based on the percentage of hospitals that earned an A in the current Safety Grades. For fall 2025, Leapfrog found:

  • The top five states for percentage of A hospitals are Utah, Virginia, New Jersey, Connecticut, and North Carolina.
  • Utah ranks first for the fifth consecutive Safety Grade round.
  • Iowa, North Dakota, Vermont, and Wyoming have no A hospitals.

See the full state rankings at hospitalsafetygrade.org.