The Leapfrog analysis revealed that 90 percent of hospitals with a fall 2025 Safety Grade are part of a health system. Among hospitals with an A- grade, the likelihood of being affiliated with a system is slightly higher, at 94 percent. This also holds true for “Straight A” hospitals—hospitals earning an A grade for more than two consecutive years—with 95 percent of the 358 Straight A hospitals being part of a health system.
The Fall 2025 report found that the top five states with the highest percentage of A hospitals are Utah, Virginia, New Jersey, Connecticut, and North Carolina. Utah remains in the top spot for the fifth consecutive Safety Grade round. Iowa, North Dakota, Vermont, and Wyoming have no A hospitals. Full state rankings for fall 2025 can be found here: hospitalsafetygrade.org.
“We have migrated to one [EMR] platform... it allows us to really focus on like-size hospitals... all supported by the same technology platform,” David Banks with AdventHealth explained when asked about what’s driving 94 percent of “A” hospitals to be system-affiliated. “Obviously, then it allows for consistency of training, and it allows us to also then align our leadership incentives.”
Gary Kaplan with CommonSpirit answered the same question by stating that "Big systems have more resources. Big systems are willing to... move to single IT platforms. Single, ways of working that help to build a culture of safety that isn't just one hospital by one hospital, but is a property of the whole."
To the question of whether hospital consolidation can lead to safer care, Gary Kaplan responded: "I was a champion for independence... I believed that consolidation was a means to raising prices... And yet, what I've learned and seen... is that if the system... it can be done at a local level... if leadership attention is prioritized around patient safety."
David Banks answered, "No patient should be a victim of geography, right? They just happen to be in a community that has a hospital that's focused on safety. So our focus has been all of our facilities are supported by a system approach."
