One-quarter of American hospitals do not meet The Leapfrog Group’s standard for addressing never events, according to a recent report.

The finding is derived from data collected in the 2018 Leapfrog Hospital Survey of more than 2,000 U.S. hospitals. The report calls attention to official hospital policies for responding to the 29 serious reportable events as identified by The National Quality Forum (NQF). (The Leapfrog report is available online at: See the story at the bottom of this page for details of the Leapfrog policy on never events.)

The Leapfrog Hospital Survey first addressed the never event policy in 2007, finding that 53% of hospitals fully complied with the five best practices in the policy at that time. Compliance hit 79% in 2014 and plateaued there. The Leapfrog Group has since added four more best practices; compliance with all nine is significantly lower.

In 2018, 25.4% of the reporting hospitals failed to meet Leapfrog’s expanded standard. The falloff in compliance was expected because the 2018 survey was the first to ask about all nine current best practices in Leapfrog’s never events policy, says Erica Mobley, director of operations for The Leapfrog Group.

“We had seen pretty consistent performance, around 80%, for the past four years. That sounds pretty good, that 80% of hospitals were complying, but this is something that 100% of hospitals should be doing,” Mobley stresses. “We wanted to know what was keeping hospitals from complying with a pretty straightforward policy, doing the right and decent thing that all other industries would hold themselves accountable to doing if they experienced the equivalent of a medical never event.”

The decrease is somewhat understandable because the bar has been raised with the additional requirements, but Mobley says hospitals should strive for full compliance. “It is somewhat disturbing that there are some hospitals that are not willing to make this commitment and take these steps to respond appropriately if the worst happens,” Mobley offers.

Of the nine elements, the one with which the fewest hospitals complied regards performance of an annual review to ensure compliance with the Leapfrog policy, Mobley notes. “That basically means you have a policy in place. Do you conduct an annual review to make sure you have all those elements? They’re working for you? It’s very straightforward. It’s interesting that’s the one hospitals are having the hardest time with,” Mobley says. “I think I would attribute that to hospitals just not making it a priority. They think they’ve done the other elements and there’s no need to go back look at it again or worry about it anymore.”

Hospitals also fail to comply with the policy requiring them to make the never events policy available to patient and payers on request. The best practices that are more involved and more challenging to comply with are the ones for which hospitals tend to report higher compliance, Mobley explains.

Leapfrog puts new standards on its survey for a year without reporting results to gauge feedback on particular aspects. The first year of the full never events list revealed some concerns from hospitals, Mobley notes. Some facilities expressed concerns about Leapfrog’s desire to include time components for some of the best practices, such as requiring them to be performed within 24 or 48 hours. “There was some pretty strong feedback on that with hospitals saying it was not feasible to comply with that time frame in some instances. We removed that component before we put it on the survey that would be publicly reported,” Mobley says. “We aren’t going to lower our standards if hospitals are just choosing not to do something. If there are valid reasons for objecting to something, we will consider that before putting the final version on our survey.”


  • Erica Mobley, Director of Operations, The Leapfrog Group, Washington, DC. Phone: (202) 292-6813.

When a Never Event Occurs

The Leapfrog Group asks hospitals to commit to these best practices after a never event:

  • Apologize to the patient;
  • Report the event;
  • Perform a root cause analysis;
  • Waive costs directly related to the event;
  • Provide a copy of the hospital’s policy on never events to patients and payers upon request;
  • Involve patients and families in the root cause analysis when willing and able to participate (added in 2017);
  • Inform the patient and family of the action(s) that the hospital will take to prevent future recurrences of similar events based on the findings from the root cause analysis (added in 2017);
  • Put a protocol in place to provide support for caregivers involved in never events, and make that protocol known to all caregivers and affiliated clinicians (added in 2017);
  • Perform an annual review to ensure compliance with each element of Leapfrog’s Never Events Policy for each never event that occurred (added in 2017).

SOURCE: The Leapfrog Group. When hospitals say “I’m sorry.” Available at: Accessed July 29, 2019.