TWENTYNINE PALMS, Calif. — Naval Hospital Twentynine Palms has been recognized as a Leapfrog Top Hospital, a national designation awarded to healthcare organizations that demonstrate exceptional performance in patient safety, quality of care and transparency, hospital officials announced.
The award was formally accepted Dec. 15 by Naval Hospital Twentynine Palms Director Capt. Janiese Cleckley and Chief Medical Officer Capt. Lisa Gibson during the Leapfrog Annual Meeting and Awards Dinner at Gaylord National Harbor in Maryland.
The Leapfrog Group, a national nonprofit organization focused on improving healthcare safety and quality through public reporting, evaluates hospitals using rigorous, evidence-based measures. These measures span medication safety, maternity care, surgical practices, patient experience, prevention of serious medical errors, and organizational culture of safety. Hospitals earning Top Hospital status consistently meet or exceed national benchmarks and demonstrate sustained commitment to high reliability and transparency.
According to Capt. Jervia Fickens, Leapfrog Lead for Naval Hospital Twentynine Palms, the recognition reflects a deliberate, yearlong effort to strengthen systems designed to protect patients at every stage of care.
“Over the last year, the hospital focused on tightening the ‘safety net’ around every medication and procedure,” Fickens said. “More than 85% of inpatient medication orders are now entered through a Computerized Physician Order Entry system, and that system has been tested as fully meeting the national safety standard for clinical decision support, meaning it can reliably flag serious medication errors before they reach patients.”
At the bedside, medication safety is reinforced through universal use of Bar Code Medication Administration across all applicable units. Nearly nine out of 10 scannable medication administrations are completed with both patient and medication scanning, electronically verifying that the right medication is given to the right patient at the right dose and time.
“The hospital’s medication reconciliation rate signals very few unintentional discrepancies when patients transition in or out of the hospital,” Fickens said. “That directly reduces the chance of missed or duplicated medications.”
Naval Hospital Twentynine Palms also demonstrated strong performance in maternity care, with outcomes that reflect adherence to evidence-based practice. These include a zero percent episiotomy rate, 100% newborn jaundice screening, and high compliance with blood clot prevention for cesarean deliveries.
“In maternity care, attention to evidence-based practice led to outcomes that directly affect the experience of growing families in the community,” Fickens said.
The hospital excelled across multiple Leapfrog-measured domains, including both process and outcome measures. Patient safety outcomes showed an excellent Patient Safety Composite score and zero rates of several serious, preventable complications such as foreign object retention and air embolism. Rates of patient falls and trauma were significantly below national benchmarks.
Patient experience measures also ranked highly, with nurse communication in the 94th percentile nationally, doctor communication in the 93rd percentile, staff responsiveness in the 88th percentile, communication about medicines in the 82nd percentile, and discharge information in the 86th percentile. These results contributed to an overall combined score corresponding to an “A” letter grade for hospital safety.
“This Leapfrog recognition mirrors the hospital’s core mission: to provide safe, high-quality care to service members, retirees and their families in a way that honors their trust,” Fickens said. “The results show a facility that does more than meet minimum standards — it consistently achieves the standard in critical areas like medication reconciliation, maternity outcomes, never-event response and medication documentation for outpatient surgery.”
He added that the hospital’s emphasis on informed consent further demonstrates its commitment to respect, transparency and patient understanding.
“The emphasis on informed consent, including training staff, clearly identifying who is involved in procedures and using medical interpreters, underscores a commitment to respect, transparency and patient understanding,” Fickens said. “Scores in culture-of-safety leadership and staff working together to prevent errors show that safety is treated as everyone’s responsibility, not just a checklist.”
Gibson said the designation reflects the collective effort of the entire hospital team and the organization’s willingness to be open about performance.
“I am so incredibly proud of our entire team for our recognition by the Leapfrog Group as a Top Hospital,” Gibson said. “This honor reflects the commitment of every single member of our staff not only to safe, high quality patient care, but to transparency of our results and processes with our patients and community. When we are open about both our successes and challenges alike, we can continue to grow and improve the care we provide. Our Marines, Sailors, retirees and families deserve nothing less than our very best.”
Fickens said the recognition validates the hospital’s investments in technology and culture, while encouraging sustained focus on safety and quality.
“The Leapfrog Top Hospital recognition will positively impact patient care and experience by enhancing recruitment and retention of top clinical talent, strengthening patient confidence in the quality and safety of care, and supporting continued innovation in patient safety practices,” he said.
The designation also provides benchmarking opportunities, allowing Naval Hospital Twentynine Palms to identify and share best practices with other military treatment facilities. Hospital leaders said the recognition serves as a morale boost for staff at all levels and reinforces the cultural values of safety and quality that guide daily operations.
“These technical scores show up in the small moments patients remember,” Fickens said. “The nurse who scans their bracelet and medications every time, the obstetrics team that avoids unnecessary interventions, or the interpreter who makes sure consent is truly understood. CPOE and BCMA reduce near misses and actual medication errors by catching problems in real time, so patients and families see fewer surprises and more predictable, safe care.”
The hospital’s approach to serious adverse events was also a factor in its Leapfrog performance. Fickens said the facility maintains a robust never-events policy that emphasizes transparency and accountability.
“The robust never-events policy — requiring apology, reporting, root cause analysis, cost waivers, caregiver support and annual review — means that if something serious does go wrong, the hospital has already agreed to respond with transparency and support, not defensiveness,” he said.
Hospital staff across all roles contributed to the achievement. Physicians and advanced practitioners maintained full adherence to computerized medication ordering protocols and achieved high communication scores with patients. Nursing staff demonstrated strong workforce performance, high compliance with bedside medication scanning, exceptional patient communication and responsiveness, and consistent hand hygiene practices. Pharmacy and medication safety personnel supported medication reconciliation and decision support systems designed to prevent wrong-patient, wrong-dose and wrong-medication errors. Support personnel and clinical leadership contributed to zero rates of certain preventable complications and supported safety culture measurement and feedback systems, while administrative and executive leaders established the infrastructure for continuous monitoring and quality improvement.
Looking ahead, hospital leaders plan to focus on sustaining “A” letter grade performance, optimizing existing safety systems, investing in staff development, expanding data analytics and exploring emerging technologies to further strengthen patient safety.
Within the Military Health System, the hospital’s Leapfrog profile demonstrates that military treatment facilities can meet and sustain civilian national quality benchmarks while supporting operational readiness and caring for patients in medically underserved areas.
By aligning national safety standards with military medicine’s unique mission, Naval Hospital Twentynine Palms’ Leapfrog Top Hospital recognition underscores its role in delivering safe, reliable and high-quality healthcare in support of the Defense Health Agency’s commitment to the health and readiness of service members, retirees and their families.