SIOUX FALLS, S.D. — North Dakota is one of three states without a top-graded hospital for patient safety, according to a widely-respected yet disputed industry review, with Sanford Health facilities earning the worst rankings in the state.

The grades, calculated by rankings firm The Leapfrog Group, found only two of the of the state's seven largest hospitals obtained a B grade: Altru Health System in Grand Forks and CHI St. Alexius Health in Bismarck.

Sanford Health earned D rankings for its three large hospitals in the state, including the Sanford Medical Center in Fargo, which opened in 2017.

“Looking at this hospital in particular, they are really struggling with a lot of their infections," said Erica Mobley, vice president of administration for The Leapfrog Group. "There are five different infections that we look at in the safety grades, and they’re scoring well below the national average in all five of them."

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Sanford Health leadership disputes the rankings. Unlike the three out of the five largest health systems in the state, it doesn't directly participate in the group's safety ratings.

“Many health care systems, including Sanford, choose to not participate in the Leapfrog survey," said Dr. Jeremy Cauwels, senior vice president of quality for Sanford Health, in an emailed statement. "Sanford is focused on quality and safety. We regularly meet and exceed our own standards that are equal to or stronger than national benchmarks.”

For hospitals that don't directly report their safety data, Leapfrog uses information collected by the federal Center for Medicare and Medicaid Services, and an annual survey conducted by the American Hospital Association to analyze 28 measures related to patient safety and release them in twice-yearly report cards.

Alaska and Wyoming were the other two states without an A-rated hospital in the Fall 2019 rankings. Only 36 hospitals nationwide obtained that score.

Battle for safety grades

Patient safety is no small concern for hospitals and patients alike. A growing awareness over the last several decades of the dangers posed by medical errors has transformed how many hospitals and health care facilities do business. But it can still be very difficult for patients to determine how safe they are at their local hospital.

While Leapfrog's work is regularly cited as authoritative, the grades have made the nonprofit group a regular target for health systems who have called its methodology into question.

Tim Blasl, president of the North Dakota Hospital Association, echoed some of those concerns on behalf of his organization's members. Blasl said it seems clear to him that hospitals that don't submit their safety data to Leapfrog get lower grades. And he said the number of safety grades out there make it less clear Leapfrog's are accurate.

"At the end of the day, our hospitals are committed to quality and safety, there’s no doubt about it," he said. "We just have some issues with Leapfrog and the way they go about doing things."

Mobley, of the Leapfrog Group, said it's inaccurate to claim hospitals that don't participate in the Leapfrog grading get worse scores.

"They’ll try to claim if you don’t report to the survey you’ll get a lower grade, and that’s not true, or that Leapfrog is only doing this because they want hospitals to report to their survey and that’s also not true," she said. "We’re a nonprofit organization. We’re doing this as a public service because we think people deserve to know this information.”

Leapfrog Group is a non-profit group formed in 2000 by large employers and public purchasers of health care after the release of the then-Institute of Medicine’s report To Err is Human, with indicated about 98,000 lives were lost every year due to preventable medical errors.

Essentia Health joined Sanford in not participating in the Leapfrog survey. Tara Ekern, a spokeswoman for Essentia, said the organization does still support public reporting of safety data. She pointed patients toward the federal Hospital Compare website available through

In Leapfrog's rating, Essentia's facility in Fargo earned a grade of C.

Hospitals tout rankings as 'progress' measure

Several health system leaders held up participation with the Leapfrog Group as a sign of their commitment to improving their work in the community, even if the grades they received were less than ideal.

"Hospitals that voluntarily submit their data to the Leapfrog Hospital Survey are to be commended for their commitment to transparency and educating their patients about the quality and safety of the care they provide," said Randy Schwan, vice president of Trinity Health in Minot, whose hospital got a C grade.

"We use Leapfrog metrics and other standards to improve our processes. This has improved our documentation of care and we confidently expect our results to continue to rise given our solid progress on these initiatives."

CHI St. Alexius Health in Bismarck and Altru Health in Grand Forks also touted their involvement with Leapfrog's surveys.

Mobley, with the Leapfrog Group, said there's been something of a shift among hospital leaders since Leapfrog began issuing its twice-yearly grades.

"They’re actually owning up to the fact that they do need to make some improvements and using it as an opportunity to make a commitment to their community that they recognize they have some challenges," she said. "They’re really committed to fixing those problems and making their hospital a safer place for care so that their community can be reassured they’re going to be safe when they’re going to the hospital there.”

Cut hospital errors

Three tips for hospital patients to reduce the risk of medical errors, from Erica Mobley, vice president of administration at The Leapfrog Group.

Have an advocate nearby: "Whenever possible, have a family member or friend at the hospital. When you’re in the hospital you’re not operating at 100 percent, so having someone there who can carefully observe what’s happening, speak up if they sense that something might be wrong, and really be the patient’s advocate, can be tremendously helpful in preventing an error.”

Make sure hands get washed: "Something all patients should do is make sure that every single person walking into their room, particularly caregivers, are washing their hands. That is the most effective way to prevent infection, and it’s very disturbing how many physicians and nurses don’t wash their hands between patients.”

Write a medications list: "Patients should bring a list of all medications they’re taking to the hospital with them, in case a doctor isn’t aware of all the medications a patient was taking previously,. They might inadvertently prescribe something that has a negative interaction with the medication they already have, because they just didn’t know about it."

Disclose all medical history: "The patient should be sure to give their doctors as much information about their past medical history.”