Becker's Hospital Review has named the 10 best hospitals in America for 2009. These organizations are leaders in all elements of quality care, drivers of innovation and trendsetters. Their success is recognized by the likes of U.S. News & World Report, Thompson Reuters, HealthGrades, Leapfrog, their communities and industry associations. They are models businesses and establish the bar for excellence.

Here are the hospitals, in alphabetical order.

Duke University Hospital (Durham, N.C.)

Duke University Hospital is one of noblest of hospital award-winners and you might even think of it as close to being king. This is one of a rare breed of institutions to place in the honor rolls of both major hospital ratings systems. This year it was named on U.S. News & World Report's Honor Roll for its 21 Best Hospitals and won the Everest Award, given to Thomson Reuters' top 25 hospitals. Only one other hospital, Vanderbilt, achieved this distinction, showing just how different rating systems can be. Both U.S. News and Thomson Reuters examine measures such as mortality and patient safety, but while Thomson Reuters also looks at business concerns such as length of stay, expenses and profitability, U.S. News bases one-third of its score on physicians' opinions.

Duke placed 11th on U.S. News' list and was among the top 10 in U.S. News' specialties of gynecology, geriatrics, orthopedics, respiratory disorders, urology, ophthalmology, heart and heart surgery and cancer. The hospital also has won the Leapfrog Award and a citation from the AHA-McKesson Quest for Quality, reflecting the success of Duke's Safe Choices program, which empowers staff to improve safety by understanding the importance of behavioral choices in everyday patient care.

The 924-bed academic medical center has 10,412 full-time employees, of which about 15 percent have a medical degree, doctoral degree or both. Among recent technological breakthroughs, Duke became the first hospital to establish a center dedicated exclusively to cardiovascular MRIs, in 2001.

Johns Hopkins Hospital (Baltimore)

Think of Johns Hopkins as the brightest kid in your class. You thought you had aced the physics midterm but Johns Hopkins did much better — as usual. In 2009, the Baltimore teaching hospital topped U.S. News' list of Best Hospitals in 2009, and it has done so every single year since 1991. This year, U.S News rated Hopkins No. 1 in otolaryngology, rheumatology, urology and geriatrics; No. 2 in gynecology, neurology and neurosurgery, ophthalmology and psychiatry; No. 3 in cancer, digestive disorders, diabetes, heart and respiratory; and No. 5 in orthopedics.

However, just as math geniuses may not be so outstanding outside of math class, Johns Hopkins doesn't shine quite as much in other hospital rankings. Still, the U.S. News rankings are probably the most sought-after, and the 982-bed academic medical center has a rich reputation in academic medicine. It practically invented the concept of the teaching hospital, having coined such terms as residents, rounds and house staff. Hopkins researchers won the Nobel Prize for discovering restriction enzymes that began the genetic engineering industry and they developed the first "blue baby" operation, which opened the way to modern heart surgery.

But rather than rest on these grand laurels, Hopkins has also attended to the day-to-day challenges of running a hospital, such as rewarding its nursing staff and treating patients like human beings. Hopkins received Magnet Recognition for nursing excellence and innovations in nursing practice from the American Nurses Credentialing Center in 2003. And in 2009 it won the National Research Corporation's Consumer Choice Award as the hospital highest-rated by patients in the Baltimore area.

Lehigh Valley Hospital (Allentown, Pa.)

Billy Joel sang, "they're closing all the factories down" in his 1982 hit, "Allentown." Those lyrics hit home again this year, as Mack Trucks moves its headquarters from Allentown to Greensboro, N.C., taking another 1,000 jobs away. But throughout these travails, Lehigh Valley Hospital has not only survived but thrived at a high-quality level, making it a beacon for every hospital as we face the current recession.

Lehigh Valley is living proof that a hospital does not have to be a huge academic medical center to perform at the highest levels. This 514-bed hospital is a clinical campus of Penn State University College of Medicine and has 1,100 physicians on staff, including 400 who are employed by the health network. With 10,000 employees, the hospital operates the state's third largest heart surgery program, with more than 1,200 open-heart procedures a year and the fourth-largest cancer program in the state. It offers a regional referral burn center for critical care burn patients and maintains national certification as a primary stroke center.

The hospital has placed in the U.S. News rankings for 14 consecutive years, including eight times for heart care and heart surgery. In 2009 it ranked in U.S. News' specialty roster in geriatric care and urology. It also appeared on HealthGrades' list of 50 Best Hospitals, a distinction that none of the hospitals on U.S. News' Honor Roll achieved, although several of these big names were on HealthGrades' list of Distinguished Hospitals for Clinical Excellence, as was Lehigh Valley. The hospital also won NRC's Consumer Choice Award for its region, was a Leapfrog Top Hospital in the Nation in 2008 and received Magnet Recognition by the American Nurses Credentialing Center in 2002. The hospital's parent, Lehigh Valley Health Network, was named one of the "100 Best Companies to Work For" in the nation by Fortune magazine this year, for the third consecutive year.

Massachusetts General Hospital (Boston)

You can ignore the genuflections at Massachusetts General Hospital, the third-oldest hospital in the nation, for its Bullfinch Building and its "ether dome," because this Boston behemoth is achieving plenty of honors in the here and now. It is the major teaching hospital of Harvard University, with one of the largest hospital-based research budgets in the world. Its researchers have many recent achievements, such as creating a strip of pulsing heart muscle from mouse embryonic stem cells, which is an important step toward growing replacement parts for hearts damaged by cardiovascular disease. Mass General is leading hospitals into the digital age, achieving 100 percent implementation of computerized order entry and convincing the great majority of its physicians to switch to electronic medical records.

Mass General is so big and influential that it has been called, in jest, "the medical industrial complex." The 900-bed medical center has more than 10,000 employees, making it the largest non-governmental employer in Boston. It admits 47,000 inpatients, handles nearly 1.5 million outpatient visits and performs 37,000 operations annually.

U.S. News ranks it fifth among hospitals overall, with the following specialties in its top 10 rankings: psychiatry, diabetes, orthopedics, digestive diseases, geriatrics, heart, kidney, neurology and neurosurgery, ophthalmology, respiratory diseases, rheumatology, cancer and gynecology. This important teaching hospital can also compete on an attribute often identified more with small, cozy community hospitals: friendliness. This year U.S. News identified Mass General as one of the 17 hospitals in the nation with the friendliest nurses. The Boston hospital also won the American Nurses Credentialing Center's Magnet Hospital award in 2003.

Mayo Clinic (Rochester, Minn.)

While Mayo Clinic is often thought of as a large multispecialty practice, it is very much an inpatient operation, using two major facilities — 1,265-bed Saint Marys Hospital and 794-bed Rochester Methodist Hospital. As a world-famous clinic with a rich history, Mayo promotes its own set of traditions, such as no "the" before its name, no apostrophe in St. Marys Hospital and, no, its name is not "Mayo's."

Mayo has been running a very close second to Johns Hopkins for almost two decades in the U.S. News rankings. This year, Mayo ranked No. 1 in diabetes, digestive disorders, neurology and neurosurgery and orthopedics; No. 2 in heart and heart surgery and respiratory disorders; and No. 3 kidney disorders, gynecology and urology. Back in 1990 was the last time that Hopkins lost U.S. News' No. 1 spot, and it was to Mayo. Both institutions are so close in quality that the difference is well nigh imperceptible, but being No. 2 can still be exasperating. "We appreciate the U.S. News recognition, but what the magazine doesn't capture in its rankings is how those 'players' work together as a team," Mayo CEO Glenn Forbes, MD, wrote of this year's listings.

But the clinic's team-based approach, the "Mayo Clinic Model of Care," has gained favor with President Obama and other health reform advocates. This approach, melding inpatient with outpatient care, has been shown to reduce costs and uphold quality. "We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio and other institutions can offer the highest quality care at costs well below the national norm," the president wrote in a letter to Senate leaders in June.

NYU Langone Medical Center (New York)

NYU Langone has the kind of exceptional quality that attracts grand gifts. This New York medical center's new name, unveiled last year, honors Home Depot founder Kenneth Langone, who has honored it with more than $200 million. The center's 726-bed Tisch Hospital honors another benefactor, the late billionaire and former CBS-owner Laurence Tisch. Even with the recession ripping through many a New York fortune, the hospital keeps attracting more gifts. When it received a $100 million donation this June, it was the fourth nine-figure gift in 15 months.

The generosity is being put to good use. The June donation is targeted for a state-of-the-art neuroscience institute, and this summer the medical center launched a Center of Excellence on Urologic Disease, using a $5 million gift for a new prostate cancer center and a $1 million gift to study innovative diagnostic technology. Moreover, this largesse hasn't diverted the hospital from making the small, incremental achievements that make a hospital great. Employees created a guide for discharge instructions that led to improved patient satisfaction and they reduced flash sterilization of equipment from 60 percent to fewer than 20 percent. They revamped breast implant procedures, cutting back serious infections from 5 percent to 1.25 percent. The hospital also increased specialty-certified nurses to 33.8 percent in 2009 from 27.6 percent in 2008.

These kinds of accomplishments have generated a long list of distinctions. This year NYU Langone placed 17th on the U.S. News Honor Roll, scoring within the top 21 slots in rehabilitation, orthopedics, neurology and neurosurgery, heart and heart surgery, psychiatric care, geriatrics and urology. It achieved Magnet Recognition by the American Nurses Credentialing Center in 2005, was a Leapfrog Top Hospital for Patient Safety in 2008. In addition, NYU's Hospital for Joint Disease has been designated a UnitedHealth Premium Surgical Spine and Total Joint Replacement Specialty Center for 2007- 2009.

Ronald Reagan UCLA Medical Center (Los Angeles)

Like its presidential namesake, the Ronald Reagan UCLA Medical Center's reputation just seems to get better. This year the hospital placed third in U.S. News' rankings, edging out luminaries like the Cleveland Clinic and Massachusetts General Hospital. In U.S. News' rankings by specialty, Ronald Reagan placed in the top 10 in an astounding breadth of categories: geriatrics, urology, psychiatry, digestive disorders, ophthalmology, rheumatology, kidney disorders, neurology and neurosurgery, ear, nose and throat, gynecology and heart and heart surgery.

The 520-bed medical center is brand new, having been totally rebuilt in accordance with the latest California seismic safety requirements, reopening in June 2008. The one million-plus square-foot structure, soaring 10 stories, was designed by the renowned architect I.M. Pei and his son, C.C. Pei. It features large, sunny, private patient rooms with terrific views and daybeds for family members, wireless Internet access for patients and guests and outdoor play areas.

In addition to the U.S. News distinction, the hospital received Magnet Recognition by the American Nurses Credentialing Center in 2005 and was a Leapfrog Top Hospital for 2007. The National Cancer Institute designated Ronald Reagan's Lung Cancer Program a Specialized Program of Research Excellence. The Integrated Healthcare Association ranks UCLA Medical Group one of California's top performing physician organizations in 2009, for the fifth straight year. UCLA Medical Group is also a qualified data registry under the 2009 Physician Quality Reporting Initiative (PQRI), a Medicare pay-for-reporting program.

University Medical Center (Tucson, Ariz.)

University Medical Center pushes the quality envelope in many directions. It oversees a large, high-tech research enterprise that recently developed a two-drug therapy to reduce the risk of recurrent colorectal polyps, and yet it is also the home of Andrew Weil, MD, the bearded founder of integrative medicine, which prefers botanical medicines rather than prescription drugs.

While UMC Tucson barely placed in U.S. News' 2009 specialty rankings, which lean heavily toward long-established university centers, this 38-year-old hospital — comparatively young, as teaching institutions go — fared much better in Thomson Reuters' survey, which gives more weight to objective measures than U.S. News. Thomson Reuters recognized UMC Tucson this year as one of only 15 major teaching institutions on its list of Top Hospitals and gave it the elite Everest Award, which goes to the top 25 on its overall list. As further proof of this hospital's coming of age, it won the University HealthSystem Consortium's Quality Leadership Award this year. UMC Tucson also won the Consumer Choice Award for its region from the National Research Corporation in 2009 and the Magnet Recognition by the American Nurses Credentialing Center in 2003.

The 355-bed hospital is part of the Arizona Health Sciences Center, adjacent to the University of Arizona Colleges of Medicine, Nursing, Pharmacy and Public Health. The medical center was part of the university when it was founded in 1971, but is now a separate, non-profit organization, though it still keeps strong ties with the university. The center, Arizona's only academic health sciences center, maintains a growing presence on the Phoenix Biomedical Campus.

University of Michigan Hospitals and Health Centers (Ann Arbor)

Research spending at the University of Michigan exceeded $1 billion for the first time this year, and 41 percent of those funds were NIH grants for studies on new anticancer drugs, brain tumors and heart disease, to name a few. While the university is one of the nation's top five research centers in R&D expenditures, U-M Hospitals and Health Centers pay close attention to basic patient safety measures. Among process measures that hospitals report to CMS, U-M scored 100 percent for testing heart failure patients to measure the ejection fraction of the heart's left ventricle and for giving heart attack patients an aspirin upon arrival and discharge.

U-M Hospitals and Health Centers is a sprawling enterprise in Ann Arbor, including University Hospital, C.S. Mott Children's Hospital, Women's Hospital, 120 outpatient clinics and some 40 health centers. In 2008, it counted 2,707 physicians, 1,074 residents and 3,800 nurses, serving 930 beds and 66 ORs that generated 44,683 total surgical cases. It has 179 ICU beds, one of the highest numbers in the country, and its Michigan Transplant Center is one of the busiest in the country, having performed over 7,100 solid organ transplants since 1964.

U-M has been a top performer in several best hospital contests, which tend to have very different slates of winners. It was on U.S. News' Honor Roll this year, placing 14th overall and scoring within the top 21 hospitals for ear, nose and throat, rheumatology, urology, heart and heart surgery, ophthalmology, diabetes and endocrine disorders, kidney disorders, cancer and rehabilitation. It is also named as one of 15 major teaching hospitals in Thomson Reuters' 100 Top Hospitals this year and it was one of the Leapfrog Top Hospitals in 2008. It received the 2008 Lindberg Bell Award from the International Association for Healthcare Security & Safety. This year it was the highest-ranking healthcare organization in the Detroit Free Press' list of "Top Workplaces 2009."

Vanderbilt University Medical Center (Nashville, Tenn.)

One challenge for Vanderbilt University Medical Center's new Critical Care Tower, which is just opening, is making sure it would have enough space for medical innovations 10 years hence. In addition to 141 new acute-care beds and 12 operating suites, the $169-million tower has three shelled floors, for future growth. That's not overly optimistic for a great institution like Vanderbilt, which is constantly on the move. This 832-bed teaching hospital ranks No. 10 among U.S. medical schools in NIH funding. It houses one of the largest DNA databases in the world, but it can also deliver basic primary care, operating more than 50 satellite clinics in Tennessee and Kentucky. The campus includes Vanderbilt University Hospital, a twin-towered building with more than 600 beds, Monroe Carell Jr. Children's Hospital and the Vanderbilt Clinic.

Vanderbilt has the distinction of being one of only two hospitals, with Duke, to be highly rated in the two major ratings systems. Vanderbilt came in 16th on U.S. News' list of Best Hospitals and was one of U.S. News' top 21 hospitals in kidney disorders, urology, cancer, diabetes, ear, nose and throat, gynecology and heart and heart surgery. It also reaped the nursing Magnet award in 2006 and the Consumer Choice Award for its region in 2009, and it was named this year as one of Fortune magazine's top 100 companies to work for.

Vanderbilt has one of the most sophisticated electronic medical records systems in the nation. The medical center pioneered EMR 10 years ago and its homegrown system is now commercialized as CareAlign. Clinical and research faculty use the system to improve medical outcomes, prompting Vanderbilt's designation in 2007 as an evidence-based practice center by AHRQ, the federal agency that studies quality of care.

Share your comments on this list or suggestions for the nation's best hospitals to Rob Kurtz (rob@beckersasc.com) or Scott Becker (sbecker@mcguirewoods.com).