The Leapfrog Group collects and publicly reports hospital data submitted voluntarily as part of the annual Leapfrog Hospital Survey. In 2024, more than 2,400 hospitals participated, representing 80% of inpatient beds across the United States.
A critical section of the survey focuses on key aspects of maternity care, including cesarean section rates for low-risk, first-time mothers and episiotomy rates.
Leapfrog NTSV C-Section Standard
The Leapfrog Hospital Survey tracks the NTSV (Nulliparous, Term, Singleton, Vertex) Cesarean rate, a nationally endorsed measure for first-time mothers carrying a single, full-term baby in a head-down position. This metric serves as a benchmark for assessing hospital performance and evaluating care for those least likely to require surgical delivery. In line with expert recommendations from its national Maternity Care Expert Panel, Leapfrog has established a benchmark to meet the Healthy People 2030 goal of an NTSV C-section rate of 23.6% or lower.
Leapfrog Episiotomy Standard
An episiotomy is a surgical incision made in the perineum to enlarge the vaginal opening during childbirth. Medical guidelines now discourage its routine use, with the American College of Obstetricians and Gynecologists (ACOG) recommending it only in specific circumstances. Leapfrog sets a benchmark for hospitals to maintain an episiotomy rate of 5% or lower among vaginal deliveries, based on expert guidance and research.
As the only organization publicly reporting maternity care quality data by hospital, Leapfrog continues to fill the critical gap in accessible information about maternity care services and outcomes. Patients can visit www.leapfroggroup.org to see individual hospital performance on these measures and more.
Holy Name Medical Center's Journey to Improve Maternity Care
In 2024, Holy Name Medical Center in Teaneck, New Jersey, received recognition at the Leapfrog Annual Meeting for presenting the top-scoring hospital poster in Leapfrog’s inaugural poster session. Their presentation highlighted impressive improvements in their NTSV C-section and episiotomy rates.
“Holy Name Medical Center’s focused work to lower their NTSV C-section and episiotomy rates is a great example of using data transparency, discussions across clinical teams and working intentionally towards shared goals to improve patient care and safety. We are proud of their work for patients in New Jersey.”- Linda Schwimmer, JD, President and CEO, New Jersey Health Care Quality Institute, Leapfrog Regional Leader and Board Chair
Click here to expand poster to full screen view.
In this interview, Leapfrog’s Director of Health Care Ratings, Katie Stewart, discusses Holy Name Medical Center’s maternity care improvement efforts with Jason Kanos, MD, Holy Name’s Chairman of Obstetrics and Gynecology.
Katie Stewart: I'm Katie Stewart, Director of Health Care Ratings at The Leapfrog Group, and I'm here with Dr. Jason Kanos, Chairman of Obstetrics and Gynecology at Holy Name Medical Center, to talk about their impressive work in improving maternity care outcomes. Welcome, Dr. Kanos.
Your hospital won the Top Poster Award at the 2024 Leapfrog Annual Meeting for your impressive outcomes in improving C-sections and episiotomies. Can you tell us more about that work?
Jason Kanos: We're happy to receive the recognition from Leapfrog, and we're very thankful that we were able to attend the meeting and present our data. A few years ago, Holy Name had a relatively high NTSV C-section rate and episiotomy rate – around 33% – and the episiotomy rate was approaching 10%. I started as chairman about a year and a half ago, and one of our goals was to lower both rates in a deliberate and systematic way.
We created an NTSV Committee that included physicians, nurses and the Perinatal Safety Nurse. This committee reviewed cases and provided feedback to the providers and nurses involved. We also started a laborist program, and we’re happy to report that next month, we'll have almost full coverage for the laborists. Research has shown that laborist programs help improve quality metrics, specifically lowering the NTSV and episiotomy rates.
I believe in transparency. We discuss the NTSV and episiotomy rates at our regular safety rounds on labor and delivery, at monthly department meetings and during OB quality improvement (OBQI) meetings. We also send out quarterly report cards to our physicians, comparing their metrics to the goals set by the Joint Commission and the departmental numbers. We did a lot of work, but we did it gradually, without pushing too hard all at once.
Katie Stewart: That’s really impressive, and it’s great to hear about the transparency involved—not just at the department level, but also at the individual level. Can you tell me more about the laborist program for those who might not be familiar with it?
Jason Kanos: Many hospitals are using laborists to cover inpatient OB-GYN services. Laborists are board-certified, experienced OB-GYNs who focus on hospital work, specifically covering labor and delivery. There's additional training beyond residency, although it's not a formal fellowship.
It’s a model I was familiar with at my previous institution, and when I came here, we implemented it along with midwives to help cover the floor. Laborists work in shifts — either 12-hour or 24-hour shifts — and are committed to a certain number of shifts per month as part of their contract. They work as a team, with proper sign-out in the morning, attending safety rounds and running the floor. Though they don’t perform the majority of deliveries, they do handle a fair number of them at Holy Name.
Katie Stewart: That’s great to hear. When did your maternity care quality journey begin, and what spurred it?
Jason Kanos: It probably started from the beginning, even before I came here. Holy Name had a good foundation for quality in maternity care, as well as in the gynecological and surgical areas. The hospital has been looking to grow and expand its services. We’ve had medical students on our floor for over a year, and we’re hoping to start a residency program, not just for OB-GYN but also in other areas. As part of that, you need a solid quality program with accountability. The efforts to lower the C-section and episiotomy rates we’re talking about today began about a year and a half ago when the new leadership team came in.
Katie Stewart: Are there any challenges that persist, even though you’ve seen success and are meeting Leapfrog standards?
Jason Kanos: Every day presents new challenges, and it’s part of the job. Some challenges are expected, and some are unknown. You can’t expect a straight path to success — it’s full of ups and downs. We’ve seen some fluctuations in our NTSV rate, especially due to personnel changes. When you lose members of your team, such as nursing leadership or physicians, it can disrupt the culture. With new people coming in, the culture can change, and it takes time to adapt. That change has been one of our biggest challenges.
Another challenge is getting everyone on board with the plan. Not everyone agrees on the same approach, so getting everyone aligned on the importance of lowering C-section and episiotomy rates can be difficult. Changing culture in health care takes years, and it’s a slow process. But I’m confident that with patience, we’ll get there.
Katie Stewart: How do you go about cultivating that culture of safety, especially with the personnel changes you mentioned?
Jason Kanos: It's important to understand that it’s a team effort. It’s not just about the obstetricians; it’s about everyone on the team, including nursing staff, nursing leadership, anesthesiologists, pediatricians and administrative and quality teams. You need everyone to understand the issues and be on board with the approach. That takes time, but it’s a process you have to be patient with. There will be ups and downs, but with determination, you’ll get there. You also need to use proven, scientific measures. At Holy Name, we use practices that have been successful in other larger institutions to lower the NTSV and episiotomy rates.
Katie Stewart: That makes a lot of sense. What motivates Holy Name Medical Center to participate in the Leapfrog Hospital Survey, considering it’s a big undertaking to get everyone on board with those metrics?
Jason Kanos: The motivation for participating in the Leapfrog Hospital Survey is simple — we want to provide the best patient care. We want to provide high-quality, modern care that results in good patient outcomes and patient satisfaction. Participating in organizations like Leapfrog helps hold us accountable, sets standards and allows us to compare our data with other institutions. It helps us improve patient care in a meaningful way.
Katie Stewart: Accountability is definitely key. How do you engage staff and leadership in meeting these standards to make sure everyone is on board with lowering the NTSV rate or episiotomy rate?
Jason Kanos: It’s not just my plan — it’s a team effort. We started by getting a small group to agree on a plan, and then we presented it systematically and scientifically. It’s not just about my opinion; the evidence from other institutions shows that these measures work. It’s important to present this information in a way that respects people’s perspectives and not to point fingers or blame. Once people start seeing results, they begin to understand the value of the approach. Recognition from Leapfrog has certainly helped demonstrate that the measures we’ve taken are making a difference.
Katie Stewart: What advice would you give to other hospitals looking to improve their maternity outcomes and participate in the Leapfrog Hospital Survey?
Jason Kanos: First, start reporting to Leapfrog right away. You need to be open to transparency with a national body. Look at what other hospitals have done to succeed and see which aspects of their programs can be applied to your own. What worked at Holy Name may not work at another hospital, but you can learn from others and adapt those ideas. Also, understand that changing the culture in a hospital is a slow process, and that’s okay. It doesn’t all need to happen in the first year. Stay patient, keep going, and if you’re systematic about it, you’ll see success.
Katie Stewart: Great advice. Is there anything else we haven’t touched on about your journey or the improvements you’ve made?
Jason Kanos: I think we’ve covered it all. I want to thank Leapfrog and you for recognizing us and highlighting the importance of sharing this information. I also want to thank my team—nursing leadership and our quality team members—for all their work on this project.
Katie Stewart: Well, thank you! It’s been a pleasure speaking with you, and congratulations to you and your team.