HCA, AdventHealth boost Florida to 15th in Leapfrog hospital safety rankings

Florida ranks No. 15 in the nation for hospital safety in the latest grading by the Leapfrog Group, with 37.9% of its hospitals earning an “A.”

The fall 2025 report underscores a major shift in U.S. health care: large health systems are now overwhelmingly driving the nation’s highest safety performance.

Two of the systems with the biggest presence in Florida, HCA Healthcare and AdventHealth, are among the three best-performing chains in the country.

Leapfrog’s new system-level scoring, launched this year, found that 94% of all "A" hospitals nationwide are part of a health system. Just one in 10 is independent, and the systems that dominate states such as Florida are emerging as the nation’s strongest performers in preventing patient harm.

HCA Healthcare — the largest hospital operator in Florida — tops the national list with 51 hospitals earning A grades and 18 receiving Straight A recognition (A’s for at least two consecutive years). AdventHealth ranks third nationally, with 29 A hospitals and 21 Straight A hospitals.

Both systems have extensive footprints across Florida, a factor that likely boosted the state’s overall ranking.

Florida’s ranking places it ahead of populous states such as New York and California but well behind top states such as Utah, which has led the nation for five consecutive grading cycles. Four states — Iowa, Vermont, North Dakota and Wyoming — recorded no "A" hospitals.

Consolidation becomes central to safety outcomes

Leah Binder, president and CEO of the Leapfrog Group, said the organization began analyzing performance by health system because consolidation has reshaped hospital care in the U.S.

“Some systems are doing an excellent job with safety,” Binder said. “They have a plan. They have a strategy at the system level for how they are going to drive better and safer outcomes for their patients.”

NATIONAL: Where did your hospital finish in the latest Leapfrog report?

The data show the depth of the shift: 95% of Straight A hospitals are system-affiliated, and one in eight hospitals maintained "A" grades for more than two years. Eleven hospitals nationwide have earned an A in every one of the 27 grading cycles since Leapfrog launched the report.

Binder said consolidation has been criticized for driving higher prices and reducing competition, but the new data suggest a potential offsetting benefit — a consistent and measurable improvement in safety when systems operate with shared standards and shared technology.

Florida’s results reflect metro vs. rural

Florida hospitals largely maintain strong patient safety performance, with many of the state’s largest systems earning high marks from Leapfrog. AdventHealth, UF Health, Orlando Health, and Baptist Health have multiple hospitals with straight A grades, reflecting consistent attention to quality and safety.

FLORIDA: How did your hospital fare in the Leapfrog safety rankings?

Not all hospitals perform at the same level. Some facilities, particularly smaller or rural hospitals, show mixed results with B, C, and a few D grades. Critical access hospitals often fall into this group, highlighting the challenge of maintaining top safety standards statewide.

A clear geographic pattern emerges, with A hospitals concentrated in metro areas such as Orlando, Tampa, Miami, and Jacksonville, while rural counties show more variability. Leapfrog data show that hospitals can improve over time, as several have moved from lower grades to A or B ratings in recent cycles.

Tampa General Hospital, an independent nonprofit with an expanding footprint, has consistently received C grades in Leapfrog’s safety evaluations.

ALSO READ: South Florida hospitals, Leapfrog Group seek court ruling over safety grades

Overall, Florida has a strong base of high-performing hospitals, but low-scoring facilities and legal disputes like Tenet’s highlight areas for improvement. Patients and policymakers continue to rely on these grades to identify safe hospitals and guide safety initiatives.

Grades for five Tenet Healthcare hospitals in South Florida are notable: four with "D" grades and Delray Medical Center receiving Florida’s only "F." The hospitals have filed a lawsuit against Leapfrog, alleging a “rigged” methodology and pressure on hospitals to pay for memberships. Leapfrog denies that, but the low scores underscore tensions between hospitals and rating organizations over patient safety evaluations.

AdventHealth: “You have to put the flag in the ground”

AdventHealth president and CEO David Banks said his system’s performance reflects decisions made years ago to unify technology, training and leadership incentives.

“We have migrated to one [electronic medical records] platform,” Banks said. “It allows for consistency of training, and it allows us to also then align our leadership incentives.”

Safety improvements, he said, depend on system-level investments in bar coding, computerized order entry and other tools that reduce human error. But culture matters as much as technology.

“Leadership have to put the flag in the ground and say the first deliverable we owe as part of our responsibility to the community is safe care,” Banks said. “We’ve built the systems that make it more possible for our frontline clinicians to get it right.”

Leapfrog is a nonprofit advocating for patient safety. Its biannual grading evaluates more than 3,000 hospitals on preventable harm, such as infections, medication errors, injuries, staffing levels and patient communication.

Leapfrog estimates one in four hospitalized patients experiences some form of preventable harm, contributing to up to 250,000 deaths annually.