U.S. News & World Report put greater weight on patient outcomes in its 2026-27 Best Hospitals rankings, released Aug. 4.
Twenty hospitals made the Honor Roll, which recognizes hospitals for performance across specialty rankings and procedures and conditions ratings. This year, maternity care was also incorporated into Honor Roll scoring.
The methodology placed greater emphasis on outcomes across most data-driven specialties. The biggest shift came in cardiology, heart and vascular surgery, where 41 risk-adjusted patient outcomes now account for 80% of a hospital’s score, up from 45%.
Leaders at Honor Roll hospitals pointed to a common set of operational levers behind their outcomes performance: high-reliability practices like tiered huddles, systemwide accountability that reaches frontline staff and data-based tracking that catches concerning trends early enough to act on them. Several also described embedding those goals across clinical, operational and quality teams rather than treating outcomes as a quality-department initiative alone.
Becker’s connected with six leaders at Honor Roll hospitals to learn what their organizations are doing operationally that most directly drives outcomes performance and what other systems could replicate. Four themes emerged.
1. Layer interventions year over year and do not change course midstream.
One account came from Rachel Sisodia, MD, chief quality officer of Somerville, Mass.-based Mass General Brigham, who told Becker’s the system’s quality turnaround began with what she called “a pretty harsh look in the mirror.” In 2022, its inpatient mortality and hospital-acquired infection rates were in the bottom half of the country on external benchmarks, while poor “quiet-at-night” scores raised concerns about sleep, delirium and falls.
The resulting strategy, For Every Patient, is built on a Donabedian framework of structures, processes and outcomes and organized around parallel buckets, including effectiveness, patient experience and ambulatory equity. Rather than moving on before a problem was resolved, the team layered interventions inside each bucket year over year. Mortality reduction took a three-year build: documentation and data in year one, an early warning system to catch deteriorating patients in year two and a systemwide sepsis push in year three, including new PCR machines for faster speciation, an antibiotic stewardship team, closer coordination with the lab and unit scorecards tracking time to antibiotics.
That layered focus moved Mass General Brigham’s hospitals from the bottom half nationally on mortality to the top 10th percentile. The same approach is now being applied to C. diff, CLABSI and CAUTI.
“We never whiplashed our staff,” Dr. Sisodia said.
That discipline — staying on one problem long enough to solve it — set up a second point Dr. Sisodia and other leaders raised: what happens once the improvement shows up in the data.
2. Treat rankings as a byproduct, not the target.
Several leaders said naming outcomes as the goal is what eventually produces the recognition.
“It’s more important to be good than to look good,” Dr. Sisodia said. “We focus on the bread and butter quality measures that we know matter for the communities we serve here. And we’ve always taken the position that if we do that and do that well, the [rankings] will take care of itself.”
Marc Boom, MD, president and CEO of Houston Methodist, described the same sequencing. The system starts with safety, quality, service and innovation and tracks them consistently across the organization, he said.
“We’ve found if we focus on the fundamentals, the awards will follow,” Dr. Boom said.
3. Align clinical, operational and quality teams around the same outcome goals.
Where those goals live inside the organization matters as much as what they are. Leaders repeatedly framed outcomes as a shared operating target rather than a quality-department project.
Paul Casey, MD, chief medical officer of Rush University System for Health in Chicago, said success comes from a relentless focus on the outcomes that matter most to patients, supported by a culture of safety, high reliability, continuous improvement and accountability.
“By aligning clinical, operational and quality teams around shared outcome goals, we create a system that consistently delivers exceptional care,” Dr. Casey said, calling it an approach any organization willing to make outcomes and patient safety central can replicate.
Anne Klibanski, MD, president and CEO of Mass General Brigham, described the structural version of the same idea, anchoring the system’s quality work in its high-reliability transformation, with clinicians across hospitals and ambulatory sites driving improvement against measurable goals including mortality, safety, efficiency and patient experience.
4. Push accountability to the front line, and make progress visible there.
Several leaders noted that alignment among executives moves outcomes only if it reaches the units where care happens, and they pointed to specific mechanisms for closing that distance.
Dr. Boom said every employee, from physicians and nurses to housekeeping and food service staff, understands they have a role in outcomes. Real excellence, he said, comes from building a culture in which employees feel empowered and accountable to identify opportunities, solve problems and improve care.
Johnese Spisso, president of UCLA Health and CEO of UCLA Hospital System in Los Angeles, pointed to change-management practices including tiered huddles, leadership escalations and a Just Culture, alongside work on patient and family experience, a consistent lens on what provides value for patients and support for clinician well-being.
Redonda Miller, MD, president of The Johns Hopkins Hospital in Baltimore, tied progress toward zero harm to early, data-based identification of concerning trends, multimodal campaigns to align the organization behind best practices and investment in the resources to support them. Recognition is built into the operating rhythm: An intensive care unit that holds central line-associated bloodstream infections at zero for months is asked to showcase its interventions, and the hospital produced a celebratory video featuring employees after earning a five-star CMS rating this spring.
“When we improve the quality of our care, our patients and employees win, and everyone is inspired to keep raising the bar even higher,” Dr. Miller said.
Mayo Clinic in Rochester, Minn., made a similar point about where credit belongs, saying its continued recognition across national rankings reflects the dedication, expertise and collaboration of its staff and care teams, and their shared commitment to quality, compassion and putting patients at the center of its work.
Taken together, the four themes point less to a single playbook than to a shared discipline: pick the outcomes that matter, stay on them longer than feels comfortable and push ownership of them down to where care is actually delivered.
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