The Most Critical Drivers of Hospital Safety Today: Insights from Leapfrog’s Leah Binder

Stewart Gandolf: 

Hello, and welcome to the Healthcare Success Podcast. Today, I am pleased to invite back an old guest and friend who was on the podcast, Leah. I don’t know how long it was. It was probably eight or ten years ago, at least. 

Leah Binder: 

It’s been a while. I should go back. Yeah. 

Stewart Gandolf: 

So, Leah is CEO of The Leapfrog Group. I’d love you to share your full title and what you do, and then we’ll jump straight into this. 

Leah Binder: 

Okay. Well, I’m formally President and CEO of The Leapfrog Group. We are a nonprofit. We were founded 25 years ago. We’re very excited to celebrate 25 years. 

We were founded by employers and other purchasers of health benefits who wanted to improve safety in hospitals. They wanted to do that in a way that is what you would call an extremely business‑like approach. By that, I mean they said, why don’t we just have an open marketplace and publicly report how hospitals are doing on safety, and then have them compete to get the business of our employees by delivering high‑quality, safe care? Basically, an open market approach is what they wanted. 

That’s why they started Leapfrog. On a fundamental level, we’re doing it differently now, but we are still about that approach. That’s amazing, 25 years. 

Stewart Gandolf: 

And we shared something that I did not know a minute ago about the origin story, since we’re on the origin story, about how you guys ended up with A, B, C, D, F. That’s certainly a very transparent, understandable thing. Tell us how that started. 

Leah Binder: 

That started a few years later, after we were founded. 

Stewart Gandolf: 

It started in 2012. 

Leah Binder: 
One of our board members was from California, and he said, “In LA, they started grading restaurants on their hygiene, how they were doing on the hygiene inspections that the health department did.” In the past, hygiene had been publicly reported, but no one ever paid attention to it. No one read in the paper about all the rat droppings or whatever they found in the different restaurants. Nobody reads that. 

But when they started grading restaurants and requiring them to post the grade in their window, suddenly everything changed. People started paying attention to it, and the restaurants started paying attention to it. He said within a year, there were no more C restaurants. There were certainly no C restaurants, and mostly they were all A’s at that point, because nobody wanted to be less than an A. It really did change the game. 

Basically, the board said, “Why can’t we do that with hospitals?” So we said, “Okay, let’s do it.” It was a little more complicated than “let’s do it,” but we did it. 

Stewart Gandolf: 

That’s amazing. It does work. 

Leah Binder:  

So we talked offline a little bit. 

Stewart Gandolf: 

I used to live in San Diego, and I’ve seen it in LA too, but in San Diego every single restaurant has it prominently displayed in their front window. It would actually come up in conversation, like, “You ever been to a C?” It was like, “No, I would never eat there. Why would you?” 

Leah Binder: 

Yeah, exactly. 

Stewart Gandolf: 

I have a house in Palm Springs. The city does it too now. 

Leah Binder:  

Yeah, it’s amazing. 

Stewart Gandolf: 

I have a house on Vacation Road in Palm Springs, and I get the local news. In my newsletter, it tells me which restaurants have rat droppings and cockroaches and things like that. I just think, “Ew, that’s not good.” 

Anyway, I mentioned it’s been a while since we talked. It was relatively new when we started talking, probably right after the letter grades. I’ve talked to you, and I’ve talked to others who are leaders in patient experience, patient safety, and healthcare leadership. I used to commiserate a lot: “Nobody cares. How do we fix this?” Have things gotten better in the last ten years or so, Leah? 

Leah Binder: 

Yes, they have. I am the first optimist on patient safety right now. I’m absolutely convinced that we are on the right path and that we are going to see major change in the next decade. I don’t think we’ll ever completely solve the problem of patient safety, but we are going to come very close. It’s going to be a transformed health system within a decade, just based on the progress that we have already seen. 

There are lots of folks who disagree with me and think, “It’s not good enough. We’re still complaining about the same things. There are lots of problems. The numbers are terrible.” I can give you all the worst numbers on patient safety. The big one right now is that one out of four patients admitted to a hospital suffer some form of harm that wasn’t the reason they got there. That’s a terrible statistic. That’s awful. There’s no way to sugarcoat that. 

Compared to other industries, like the auto industry, if they have one defect in a million, they consider that a serious problem. One in four is outrageous. I’m definitely not seeing this in a sugar‑coated way. 

But when we talked about patient safety 20 or 30 years ago, people would say, “It’s so horrible. Why is there never any progress? People say they want to make progress. Nothing ever happens.” It is finally happening. We are seeing progress, and the numbers are truly encouraging. 

There’s a study that came out literally this week. It’s from the Agency for Healthcare Research and Quality. It continues to show encouraging news that adverse events are down for the period of 2021 to 2023, and significantly. They’re looking at thousands of patient records. It’s very encouraging. The trends are in the right direction. Again, we need a lot more, but it’s really encouraging. 

It’s clear to me, just from my daily experience working on this issue and dealing with hospitals all the time, that they are focused on patient safety more than ever before. That is probably the number one thing that’s going to make the difference. When these clinicians have the resources they need to get this job done, they will get it done. They will fix this. I have confidence in them, and I’m seeing the progress. 

Stewart Gandolf: 

That’s really intriguing. That’s great news. Do you feel like the public is more aware? Certainly, they’re not as aware as you’d probably like them to be, but do you feel like they’re more aware over the last ten years, or is it still pretty low awareness out there? 

Leah Binder: 

I think they’re more aware for sure than they used to be. We see a lot of press and media attention in the lay press, general news media like USA Today, about progress around safety. We see a lot more stories about individuals who have had bad experiences in hospitals. We see a lot of that on the internet. So there’s more general attention toward it. 

But I don’t think it’s a household concept. I don’t think absolutely everyone knows about it. And I don’t think the public in general—people who don’t work in healthcare—realize how significant a problem patient safety is. 

When I talk to friends who aren’t in healthcare, maybe someone you meet at a party, they’ll say things like, if I say I work on issues like this—although we don’t talk about “patient safety” per se to the public. We don’t call it that, because they don’t understand what that is. We say it’s errors, accidents, injuries, and infections in hospitals. 

When I say that, they say, “Oh yeah, that happened to me.” But the way they talk about something that happens in a hospital is as if it’s a fluke, that it only happened to them, that they were really unlucky. They’ll say, “Yeah, they made a big mistake in the medication,” or something like that, but they convey it as if they’re the only ones. 

Stewart Gandolf: 

Got it. Totally. 

Leah Binder: 

You see that also in movies. There’s a terrific documentary by Steve Burrows called “Bleed Out.” It’s still on HBO; it’s been on since 2019. He talks about his mother’s terrible experience in the hospital, and he talks about it as if he’s the only one. 

I talked to him after the documentary came out, and he’s gotten very involved in the patient safety movement. The thing that struck him, what he learned from making the documentary, was that they weren’t the only ones. This is so common. 

That’s where I think the public is. They recognize there’s an issue, but they don’t realize how bad it is or how common it is. 

Stewart Gandolf: 

How common it is. Pivoting from there, you’ve mentioned a lot that safety ultimately lives and dies with the CEO and leadership team. When you walk into a hospital, what behaviors and decisions from leadership stand out to you? Give me a quick sense of that, because it makes intuitive sense to me, but I’m curious what your thoughts and insights are. 

Leah Binder: 

That’s such an interesting question, Stewart. 

Stewart Gandolf: 

You ask very interesting questions, by the way. 

Leah Binder: 

I appreciate that. 

Stewart Gandolf: 

Thank you. 

Leah Binder: 

I will tell you the number one thing I’ve decided I can use to tell a hospital that is truly outstanding versus one that has major problems: the CEO is whining. The CEO is unhappy and saying, “We’re not making enough progress.” When you talk to a CEO who thinks, “We’ve got to do better,” those are the CEOs that are driving to new heights of excellence. 

It is inevitable that when I talk to a CEO who’s won a bunch of awards from us—and by the way, Leapfrog is extremely picky about who we give an award to, because we’re looking at real numbers. We don’t want to give an award just for nice PR. We’re giving an award because they’ve actually accomplished something. 

We’ll talk to these CEOs, and they’ll say, “Okay, we did great. Yeah, we got to zero on all these infections and so on. But I’m really worried because we’ve had an issue. We had one case of MRSA, and I don’t think we’re doing enough in that area. I really think we have to do better.” They will go on and on about all the things they aren’t doing well enough, even though they’re far ahead of the rest of the country. I see it all the time with these extremely high‑performing CEOs. 

Then, when you talk to a CEO who immediately starts launching into all the great things they’re accomplishing, I immediately get suspicious, and usually with good reason. If they’re not pushing the envelope and never quite satisfied, that’s not the CEO who’s going to take us to a new level. 

We have to get to a new level. Even the top performers have to get to a new level. They’re still not good enough. We’ve got to do better as a whole country. The CEOs that are really pushing us are the ones who never, ever see it as “we’ve arrived.” 

Stewart Gandolf: 

I love that. What an awesome insight that is. That’s a life lesson there, don’t you think, Leah? I’m going to be more demanding on just about everything, it sounds like, for my own company. I can see how that would apply. 

Another thing in the news came up, I saw it maybe two days ago. This is straight from a press release that shows—so we’re going to pivot now and talk about factors for safety. Beyond the CEO and leadership teams embracing safety as an important issue, the second category that the study I just referred to highlighted was health systems. The vast majority of A‑rated hospitals are part of health systems. That’s a big deal. I don’t know if that snuck up on you or was something you anticipated, but what is it about system membership that seems to support safer care? Let’s talk about that. 

Leah Binder: 

I’m not sure that system membership per se creates or pushes for safer care. In general, what we found was that almost all of the hospitals we grade are in systems—90 to 95 percent. But for whatever reason, we had never looked at them that way. We hadn’t really examined how system membership is arrayed, how it works, and how systems play into this patient safety picture. 

What we did see is that there are clear patterns among systems. You can look at the numbers and quickly spot those where they are putting a huge priority on patient safety across the whole system. They have to be doing something system‑wide to bring resources and expertise to all their hospitals to push them. 

The one that comes to mind immediately is AdventHealth in Florida, where you see a pattern of almost all A’s. When they acquire a hospital, sometimes it’s not an A, but within a year or two, it’s an A. You can see it in the numbers: they’re driving everyone toward an A. You can also see it by talking to them, which I did in a webinar with the CEO of AdventHealth because I was so curious. 

You see this in a number of different systems where there are clear patterns. They’re exceeding the national average on the percentage of A hospitals. They’re doing something. 

So it struck us that we need to start thinking differently about systems. Consolidation is no longer something we look at as “they’re in the process of consolidating.” Now we have to look at it and say, “They’ve finished. They’re consolidated.” There may be more consolidation, but that’s the rear‑view mirror. They’ve consolidated. 

Now we have to ask, what do we expect from system leadership? Not only what do we see, but what do we expect? That’s the next era for Leapfrog. We are expecting hospital systems to bring leadership to patient safety on the ground in every unit of every hospital they own. That has to be an expectation. 

Whatever economies of scale and gains they’ve made in the marketplace by consolidating, we expect them to invest that back into the patients they’re serving, by ensuring that they deliver the highest and best possible quality of care. That’s the next thing we’ve got to do. 

Stewart Gandolf: 

That’s really interesting. I met with some of the leadership team at one of the hospitals within the Adventist Health system, St. Helena Hospital over Napa Valley. They brought this up at the beginning of my morning stay with them—how proud they were of their safety scores. They were comparing themselves on every factor not just with their competitors but with other hospitals, and they were really focused on trying to lead. 

That’s a really interesting metric. They were very proud of it. I thought that was reassuring—they really thought it was important. 

We talked about CEOs and a lot of different topics. Culture is kind of a fuzzy idea, but Leapfrog has identified culture as a leading factor. How do you decide and define what a safety culture is? How does that work? 

Leah Binder: 

We try our best with whatever literature is out there to help us understand it. The first thing we’ve always asked about is: do you do a culture of safety survey? We define what that is by looking at the literature: what is a good culture of safety survey, and does it tell us something about actual outcomes? There’s a lot of research on how those are structured, and we follow that research. 

We ask, “Do you do these culture of safety surveys?” Those are typically done with mostly nurses and sometimes other clinicians, physicians, and different staff. Basically, are you asking your staff what they think about the culture? 

We would love to see that publicly reported—obviously not identifying the individuals answering the survey—but we’d like to be able to look at that, because those are strong indicators of the actual safety of a hospital. Questions like, “Do you think it’s safe? Would you send your family here?” Those are the kinds of questions they ask nurses, and those answers are very telling. 

Stewart Gandolf: 

That’s amazing. This is so fascinating, Leah, these insights. I was like, “Wow, I didn’t know that.” That’s awesome. 

So I love this. With all the dozens of different outcomes and the things you’re looking at, you’re trying to combine them into a letter that’s accurate and defensible. When you have a hospital leader who wants to move from, say, a C to an A, and they say, “Will you help me? I’m not satisfied. I’m new here. I want to fix this,” what have you seen? What would you recommend to them? What’s the priority—the 80/20 rule, so to speak? 

Leah Binder: 

First, Leapfrog makes it very clear that we do not know how to run a hospital. We admire people who do, but we do not do it ourselves. We know how to measure performance in a hospital. We know how to spot excellence, but we don’t know how to run a hospital, and we don’t know how to get you from here to there. 

We recommend to them organizations that seem to have good approaches. We don’t endorse anybody, but we often recommend looking at IHI. They’re always on the cutting edge of a lot of good work. And AHRQ, the Agency for Healthcare Research and Quality that I mentioned earlier—they have incredible toolkits. We’re big advocates of AHRQ because they put out such valuable resources for hospitals to improve. We want hospitals to improve. 

We also like to give hospitals an overview, and we do this for free: “Here’s what the numbers tell us about you. Here’s where your weaknesses are. Here’s your strengths. Here’s what you should watch. Here’s where you could do better, although you’re doing well.” We can give them a sense of how they compare, how they benchmark with other hospitals like them. We like to give them those kinds of insights. 

That can be powerful—simply knowing, “Here’s something you have to put more attention on because you’re not competing the way you want to be.” We’re very happy to share that with hospitals. 

Another thing we’ve done with a number of hospital systems is help them identify hospitals in the country that are like them somewhere else—not direct competitors, but peers. For instance, we worked with a collaborative in Michigan—all the hospitals in the state—and we helped them identify hospitals outside of Michigan that were succeeding in reducing infections to very low numbers over a period of years, showing a pattern of really getting there. 

They identified three hospitals they wanted to interview, and they spent time with those hospitals, interviewing them to understand how they got there and what factors contributed to those great results. We were happy to help by looking at our data and identifying hospitals they could talk with that had truly outstanding results. 

We do that for a couple of other hospital systems and are happy to do it for others. Those are the kinds of things where we can point hospitals in the right direction, but we don’t do consulting on quality improvement or anything like that. 

Stewart Gandolf: 

Great. Very good. We’ve got so much to talk about. 

Just quickly, are there any measures that you wish the public would care more about? If this is overwhelming and they want to go beyond the grade—or doctors want to go deeper—what are the one or two measures that are really important to look at, if they drill a little deeper than just the letter? 

Leah Binder: 

Within our grade, if you go to hospitalsafetygrade.org and look up any hospital you’re interested in and dig in, I think we make it as transparent and easy as possible. You’ll see we have 32 measures of both outcomes—how a hospital does on terrible events that can happen—and also whether they have in place what they should have to prevent those things. 

It’s hard for me to pick which measures are most important. 

Stewart Gandolf: 

Say there’s one in particular. 

Leah Binder: 

There’s one on deaths from avoidable complications after surgery. That one, to me, is a big one. But honestly, it’s hard to pick a favorite. 

Stewart Gandolf: 

That makes sense. 

Well, let’s turn our attention. We talked about leadership. Let’s talk about nurses. From your perspective, how do nurse staff and their environment show up in these variables? 

Leah Binder: 

We have a measure on the Leapfrog Hospital Survey, which we also use in the Safety Grade, on whether a hospital has adequate nursing staff. Adequate for Leapfrog is a high standard—do they have enough nurses? 

If a hospital voluntarily reports to the Leapfrog Hospital Survey—and 80 percent of hospital beds are represented in the survey, so most hospitals are reporting, which is to their great credit, because we make everything public when we rate them from the data they give us—they are making themselves public to the people they serve. They’re doing that voluntarily, and that’s to their great credit. 

One of the things we ask about is their nurse‑patient ratios, and we use that in the Safety Grade. If they report to the survey, we’ll use that, and that can give them credit or not. It can hurt them too, if they don’t do well. If they don’t voluntarily report, we don’t use it. 

In my mind, nurse staffing ratio is a very important measure. I’d like to have more nuanced measures around nursing as well, because I know that nursing is absolutely critical to safety in a hospital. Nurses themselves are the lifeline for patients. 

If you’re in a hospital, anyone who has spent time there knows that if you do not have a nurse you trust, it is a very scary place. You have to have a great nurse you trust—not just in terms of being caring, which is important, but also smart and observant. Nurses are so smart. You have to be really intelligent to be a good nurse. The job is complicated. 

They have to be sharp clinicians. They’re not just looking at your blood pressure. They’re looking at whether your complexion looks off, whether something about your temperature feels wrong. They have to notice the subtleties that can indicate something serious is going wrong. They also have to notice socio‑psychological factors that affect your overall health. Nurses are well‑educated in those aspects of well‑being. 

Nurses are amazing people doing incredibly important work. Most of what happens in a hospital is the delivery of nursing care. It’s most of what’s going on. A large share of the workers in a hospital—often the majority—are nurses. They have to be well‑educated, well‑supported, listened to, and given real leadership roles in hospital operations for it to be safe. 

To me, that is the number one factor. If you’re looking at a hospital where nurses do not feel supported, or they’re doing a lot of workarounds to make things work for their patients because the systems don’t work otherwise, that’s not a safe place for patients. I think the most important pivotal aspect of patient safety is nursing. 

Stewart Gandolf: 

When we were preparing for this meeting, we talked about the importance of nursing like you just said, and that was fantastic. I was thinking back to our neighbor across the street. She just died recently, which makes me sad because we loved her, but she was a nurse and she was exactly what you described. She was so smart and caring. The public persona is “caring, nice people,” but she was also incredibly smart. 

She was the neighborhood thought leader. If anything went wrong with our kids when they were little, we went and talked to her. I can’t go into too much detail here because it doesn’t really fit the podcast, but she embodied everything you just said—sample size of one. 

But we talked about how the public doesn’t really understand that. There’s a new development in the news: the Department of Education decided to exclude nursing from its internal definition of what is a professional degree. They came out with a press release and there’s a lot of controversy around this. But the bigger issue is, why is it that nurses don’t get the respect they deserve in the public and elsewhere? Is it a PR problem, or what’s the deal there? 

Leah Binder: 

If you’ll forgive me, I’ll go back to my graduate school days, which were a little while ago, to say the least. 

I did my graduate school research at the Annenberg School for Communication at the University of Pennsylvania on the image of nurses in entertainment media. I did it a long time ago, but I still think it’s true today. 

The way nurses are portrayed in drama on television—which more people watch than any news—is a big part of it. Entertainment media, even today, whether broadcast or streaming, portrays hospitals as if they’re realistic. They look very real when you’re watching, but they are fantasy when you look at the numbers. 

For instance, most hospital dramas, like “ER,” show about ten physicians for every one nurse. Most of the nurses are minor characters. If they’re even there, they’re minor. Most of the physicians have significant roles. My thesis was that nurses are portrayed as “clerks in caps.” Sometimes they’re just props, with no lines, just in the room somewhere. 

On shows like “ER” or “Grey’s Anatomy,” the physicians do all the things that in a real hospital nurses do. Ninety percent of what those fictional doctors are doing is what nurses actually do. 

Most people will see more “Grey’s Anatomy” or “ER”—my kids do—than they’ll spend in an actual hospital in any given year. Most people don’t spend a lot of time in hospitals unless they work there. They might go once every five or ten years, or to visit someone, and that’s it. But they might watch twenty hours of “Grey’s Anatomy,” and they think that’s what it’s like. 

That’s a problem from so many perspectives. For one thing, my kids get subjected to my commentary. My son streams “Grey’s Anatomy” and loves it, and every time I see it, he says, “Mom, don’t get started.” And I’ll say, “Where are the nurses? Where are the nurses?” I annoy him. Can you imagine? I’m annoying my child. 

Stewart Gandolf: 

It’s shocking. That never happened to me personally. Of course not. 

Leah Binder: 

I’m the only one, I’m sure. 

But he’s not going to become a nurse unless he realizes nurses do interesting things. I think what has translated from that media portrayal is the absurd possibility of what happened with the Department of Education. They’re basically saying—though they’re only applying it to graduate programs—they’re proposing that nurses not be included in the list of professionals subject to these new rules around student loans. 

It is inconceivable that you would exclude nurses from any list of professionals. They are among the highest‑level professionals of any profession. This is an extraordinarily important job that requires the best of people. It is absolutely a profession. 

There are lots of issues about whether they should have to take out big student loans. I think we should support graduate nursing education separately, so they shouldn’t have to take out all those loans. But that’s not the issue. The issue is that they are at the pinnacle of the professionals we need. The nurses who get graduate degrees are the ones who do what we really need in our healthcare system: primary care and coordination of care for critically ill patients. We need better coordination and better primary care. Those are things nurses are superb at, and graduate nurses are specifically educated to do. 

So for us to downgrade them as non‑professionals, unlike pharmacists or veterinarians, is ridiculous. It’s a terrible insult to the profession and very dangerous for the healthcare industry as a whole—meaning those of us who need the healthcare system, like patients. 

Stewart Gandolf: 

Wow, that’s great insight, for sure. 

We talked about some of the positive things that are happening with the Leapfrog grade and what that’s done, but not everybody’s happy. I understand Leapfrog is facing a lawsuit, and I’m sure you have some comments or opinions on that. So enlighten me and our audience. 

Leah Binder: 

There are five hospitals in South Florida owned by Tenet Healthcare, which is a publicly traded company with a market cap of about 16 billion dollars. These are for‑profit hospitals in a for‑profit system. The five hospitals are in a network called Palm Beach Health Network. 

They have earned very poor grades from Leapfrog. Back in the spring, when they first brought their lawsuit, they earned D’s and F’s. This fall, we updated our grades—we do that every six months—and they again earned D’s and F’s. 

They’re saying what you might expect to hear if you have a kid who gets a bad report card: “The teacher is mean to me, and the grades are unfair.” That’s basically what they said. They say Leapfrog’s grading system is unfair, and that we’re doing it deliberately to hurt them. 

I think anyone familiar with Leapfrog knows that if we were trying to do something deliberately to hurt someone, we wouldn’t be as transparent as we are. We’re so transparent that it would be very hard for us to try to target someone for some nefarious reason. We can’t do it. We just show you the data we have and how we got there. That’s it. 

If you disagree with how we got there, we give you enough information to calculate your own grade. We give that to every hospital and to everyone who goes to our website. Everything is free to all those parties. You can look it up and decide, “I’m looking at the measures for, let’s say, Delray Medical Center”—which is one of those five hospitals—“and I think they deserve a C, because I look at all the 32 measures Leapfrog used and I think they should get a C.” Fine. We want you to judge for yourself. That’s why we give you all the information we have and how we got there. So “nefariousness” is hard to understand here because we just give you the numbers. 

Then there’s the charge that it’s unfair. We have a very elaborate process to be as fair as possible. There’s no guarantee of perfection in the world, and we don’t claim perfection, but we try our very best to be fair and transparent in how we get there. 

I don’t think there’s any other rating system that’s as transparent as we are and as fair. We give hospitals every opportunity to learn how we’re about to grade them long before we publicly report the grades. We give them insight and background, and we show the public and the hospitals themselves how we get there. 

Our process is as meticulous as we can make it, and we bring in world‑class experts to help us and advise us on making sure we adhere to the latest and best science—both clinical science and measurement science. Measurement is a whole other set of principles on how you are as fair and reliable as possible in comparing hospitals. 

They are convinced that we have gone after them, and they have waged this lawsuit. We think they’ve spent over 10 million dollars so far on this lawsuit. The one thing they want us to do is to pull down the grades of these five hospitals and not report them. 

That is the one thing we will never do, unless we’re ordered to by the courts. We will not pull down grades. We will not go backwards in this country. 

It was not that long ago—maybe 15 years—when you, as someone who would entrust your life to a hospital, could not find out how hospitals were doing on medical errors. There was no information available on medical errors for hospitals in your community or nationally. Nothing. It was blocked from you by hospitals. There was no information available. 

Leapfrog has been fighting for 25 years to change that, and we got there. We are not going back. The public deserves to know how their hospitals are doing, even if hospitals get a little offended seeing it publicly like these do. We’re not going back. 

Stewart Gandolf: 

Got it. Thank you. That was really helpful. 

Just before we wrap up, I want to talk about marketing. I have to talk about marketing—I’m the CEO of a marketing agency. I think it’s really intriguing, this idea of the public not understanding safety. There’s U.S. News & World Report rankings, and there are a lot of ways of looking at this, as well as Leapfrog. 

Specifically with your A grades, some hospitals are leaning into it. They’re communicating it publicly and externally through advertising, and internally as well. Any comments on that? I think it’s really interesting. It must be fun to watch. 

Leah Binder: 

It’s really fun to watch. We see municipal buses with huge banners: “This hospital got an A.” I love it. I think it’s a very good sign for the future that I’m so positive about for patient safety. I think it’s a sign that I’m right, because we see hospitals doing this. 

By the way, “You were right” is my favorite phrase. 

Stewart Gandolf: 

You were right. 

Leah Binder: 

Yeah, that’s another one I tell my kids that I don’t hear enough. 

Stewart Gandolf: 

Yeah. 

Leah Binder: 

I think it’s a good sign for where we’re going with patient safety when you see hospitals advertising their A’s in the community. They’re proud of that A. 

The other exciting thing is how they advertise it internally. They use their A grade to celebrate their own clinicians and staff. We get pictures all the time at Leapfrog of big teams celebrating their A in various ways. 

One I really love is a picture of a group of people all holding A banners. One of the people holding a banner is wearing a chef’s cap. It’s a chef from their cafeteria. I love that because that’s the right message. If you’re going to get an A and be safe, everybody has a role to play and everybody has to be dedicated to it. 

You can’t make that statement in a more powerful way than by seeing the celebration that includes a chef and everyone else at the hospital working together to accomplish this outcome for their patients. We see this all over the country, and it’s exciting. It sends exactly the right message about the direction we have to go as a country. It’s such a powerful way to motivate all of us to keep on track with this goal. 

Stewart Gandolf: 

I’ll make a final comment here. I love that, Leah. This has been so much fun, and I knew it would be great. I was excited when you agreed to come back on because it’s been a while. 

As you talk about this, even beyond safety, I look within our own agency at the factors we get behind. Coincidentally, we’re revising our values. The old values were good—it’s not that they were bad—but over time our focus changes, as every organization’s does. We’ve been around 20 years, so not as long as you guys, but we’ve been around a while. We’re going into our 20th year. 

We did an exercise where we looked at the favorite attributes widely accepted among our team—not made‑up aspirational values, but the traits of people we already have. I thought that was an interesting way of doing it. Our consultants said, “Don’t be aspirational to what you want.” 

Leah Binder: 

Let’s look at what you’ve got and what really drives you. That way it’s real and organic. 

Stewart Gandolf: 

Exactly. I just announced this to our employees on Friday. We have something we call the Squirrel Awards. 

That’s for the people who best live our values, which is, by the way, a bit of a dig at me. The Squirrel is like my ADD brand—squirrel. The name came from one of our employees years ago. 

It’s that internal chatter, that internal thinking. What’s great about Leapfrog’s approach is that culture is not fuzzy. You either have an A or you don’t. It’s hard to get excited about, “Yay, we’re a B. We used to be a C.” You really want to be an A if you’re going to celebrate something like that. 

Leah Binder: 

I would say, Stewart, some do. 

Stewart Gandolf: 

That’s good then, I guess. 

My point was, we talked about the “fuzzy culture” thing earlier. Culture is real. 

Leah Binder: 

Culture is very real. 

Stewart Gandolf: 

It’s something we’ve always taken seriously, but I’m leaning into it more because it’s vital. We have to live those values. You talked about the culture of safety. To live those values every day makes a world of difference between doing it and not doing it. 

I appreciate your time today. 

Leah Binder: 

This has been terrific. Thank you. Thanks for having me. It was great to see you again. Let’s not let so much time go by again. 

Stewart Gandolf: 

I hope not. Thanks. Bye‑bye. 

Leah Binder: 

Bye‑bye.