In a meeting for Mass General Brigham doctors in November 2024, Dr. Giles Boland, president of Brigham and Women’s Hospital, laid out the vision for becoming the best in the country. Thanks to a corporate merging of its hospitals, he said, the system was well on its way, making progress on delivering the best outcomes possible for patients, including its most important job — keeping people alive.
Boland specifically pointed to MGB’s strides on a metric called observed-to-expected mortality, which compares how many people died while admitted to the hospital, versus how many were projected to die, given their levels of illness.
“This is a motivating force for our people,” Boland said in the meeting, a recording of which was obtained by the Globe. “We can be proud of what we do.”
Nearly two years later, Mass General Brigham executives say they’ve continued to have resounding success. By streamlining quality metrics and focusing more intently on them, they say they have improved quality and saved the lives of at least 1,400 more people.
Executives point to Mass General Brigham’s hospitals soaring in quality rankings by Vizient, a health care analytics firm MGB called the industry gold standard. Rankings consider many metrics, including mortality stats, hospital infection rates, and how long patients stay. Unlike U.S. News and World Report’s list of best hospitals, which considers reputational scores from physician voting, Vizient’s data only looks at outcomes.
For all its academic and clinical prowess, Mass General Brigham, long the top hospital recipient of federal research funds and consistently dominating U.S. News’ lists, had declined in Vizient’s rankings for two decades. Leaders said MGB had overlooked some aspects of everyday patient safety, dropping MGH and the Brigham to 96th and 72nd place, respectively, for overall quality just four years ago compared to their peers. With its latest reforms, they said, the hospitals had risen to 37th and 36th place by 2025.
“It is remarkable work,” said Dr. Rachel Sisodia, chief quality officer at Mass General Brigham. “It is moving, and that is why we hype it.”
Some doctors, however, are deeply skeptical of MGB’s mortality achievements, questioning whether the leaders of the state’s biggest health system simply made administrative changes to its data to improve its rankings, without actually saving hundreds more lives. They haven’t noticed a dramatic drop in the number of patients who are dying, and feel MGB’s celebration of its mortality figures flies in the face of real problems that need fixing, such as long wait times to see specialists and many existing patients going without primary care.
The reservations compound what many clinicians have been ringing alarms about since the system’s hospitals started joining together in earnest — that the organization as a whole is increasingly corporatized, and the physician voice has been pushed further away from strategy decisions. Many feel those in charge are not always worthy of trust.
“Very few doctors are happy about this [integration], so they are trying to sell to the doctors why this is a good thing, because our quality of care is improving,” said Dr. Mark Eisenberg, a primary care physician and addiction specialist at Massachusetts General Hospital. “It’s a propaganda campaign.”
Seemingly amazing feat
On the face of it, the achievement was stunning.
Mass. General Hospital had cut its mortality ratio in half in the year ending in September 2024, Chief Medical Officer Dr. Will Curry told staff in an email that year.
When the number of people who die in the hospital are exactly those that were expected to die, the ratio hovers around one. MGH, Curry said, had brought its ratio from 1.1 to an “all time low” of 0.62.
A similar memo from Brigham and Women’s Hospital said that in early 2024, the hospital had “set the bar for all of MGB” on observed to expected mortality.
By March 2025, officials said in a post on MGB’s website that the integrated way the health system had approached quality and safety translated to a staggering result: More than 1,400 more lives saved at just the Brigham and MGH from January 2023 to December 2024.
The article attributed this to timely care driven by an early warning system, which uses predictive analytics to identify at-risk patients, and improving infection control. In both areas, integration had helped the hospital unify how it analyzed and acted upon these measures.
There were other factors, the article noted, including more rigorous clinical note-taking, but the biggest driver was improved quality of care.
“By maintaining this laser focus on quality, you are not just improving numbers — you are giving more families precious time with their loved ones, and that’s the heart of why we all do this work,” Sisodia said in the post.
For years, the health system said integrating its hospitals would better serve patients. Standardized protocols and reporting would elevate the quality of care throughout the system. The article emphasized that work had now paid off.
The mortality achievement appeared again in a July 2025 post, and then again in the system’s annual financials in December 2025.
CEO Dr. Anne Klibanski reiterated the achievements in an email to staff and then posting to the system’s website this month, saying when it came to mortality, the Brigham ranked fourth and Mass. General ranked 15th out of 122 other academic medical centers.
To MGB brass, the progress was the result of years of incremental work. When the health system set out to improve quality, executives began by improving the data they had. That meant making sure doctors were documenting how sick a person was, Sisodia said in an interview. Making a patient look sicker on paper can affect their expected mortality. While that change, begun in January 2023, resulted in a drop in mortality ratios, Sisodia said it was more about understanding the health system’s baseline.
The health system also began offering hospice care more widely in September 2023 to better support dying patients and grieving families, saying leaders realized they lagged in offering such care compared to peers.
That work brought MGB in line with national averages, Sisodia said. What reduced mortality rates even further, she said, came after, when MGB began using the early warning system in late 2024 that looks at patient metrics and alerts clinicians to intervene sooner.
Further drops in mortality came in October 2025, when hospitals prioritized sepsis, getting more machines to run more blood tests and instituting workflows to pair the correct antibiotic with the associated infection, among other changes.
Over the last year and a half, different units of the system’s hospitals have started holding weekly huddles, where nurses, doctors, and hospital leaders review their performance on a set of quality metrics.
On a medical/surgical floor at Newton-Wellesley Hospital in early May, hospital leadership and front-line clinicians walked through the unit’s stats, from a recent death to efforts to reduce catheter-associated urinary tract infections.
“We don’t cross our fingers every week hoping our patients don’t get an infection from a [catheter],” Kyle Dolan, nurse director at the hospital, told the group, standing in front of a screen displaying metrics. “It’s the work we do day in, day out.”
Some clinicians felt strongly that the work was translating to saving patient lives.
“These are real harm-reduction outcomes,” said Dr. Steven Pestka, an internal medicine doctor at Newton-Wellesley Hospital. “These are real, material changes in our behavior that are benefiting our patients.”
Other doctors, too, were supportive of the quality work. A specialist at MGH said reducing infections had meaningfully improved quality, and applauded the enhanced collaboration between physicians and nurses.
“It’s the right thing to do for patients,“ said the specialist, who spoke on condition of anonymity because they weren’t authorized to speak to the media. ”I’d give them the benefit of the doubt. There is a sincere desire to improve on quality and mortality."
But, the specialist added, it was hard to know what portion of the lives saved were attributable to the more recent quality efforts.
In fact for months, the alleged mortality achievement had many clinicians rolling their eyes.
Doctors’ theories
Several theories emerged among nearly 10 doctors interviewed by the Globe as to what was happening. Few believed the quality improvements had translated to over a thousand lives saved, and none believed MGB’s integration was responsible. The doctors spoke largely on condition of anonymity because they were not authorized to speak publicly and feared professional retaliation.
One Brigham doctor suggested MGB was generally increasing the number of patients it enrolls in inpatient hospice. Those patient deaths, which involve an external hospice agency but occur at MGB hospitals, aren’t officially counted in the mortality calculation.
In fact, increased hospice enrollment has been a tactic outlined in internal MGB presentations as something that would improve mortality data, according to documents reviewed by the Globe. According to slides from an October 2024 MGH doctors’ meeting, Mass. General Hospital said it was a “priority” to increase hospice enrollment from two to three patients a week to 10 to 15 weekly. The hospital had made it easier to enroll patients in hospice and was boosting hospice capacity.
The changes would benefit patients, staff, and families, who could access bereavement support for months. A final bullet point seemed like a bonus.
“Increasing [hospice] enrollment may also result in improved inpatient mortality performance — a [hospice] death does not count as an inpatient death," the slide deck said, bolding that part of the text for emphasis.
The slides outlined that better use of hospice was correlated with lower mortality ratios at the Brigham. In the second quarter of 2022, only 15 patients were enrolled in inpatient hospice, and the mortality ratio hovered around 0.9. A year later, hospice enrollment stood at 93, and the mortality ratio had fallen to nearly 0.7.
In a statement, MGB said the Brigham’s work on hospice enrollment in 2022 wasn’t a mortality initiative, and was just good care that predated the quality efforts.
Additionally, during the time MGH’s mortality ratio plummeted, MGB slides also showed inpatient hospice enrollment at Mass. General rose, from roughly less than a dozen each month in the first half of 2024, to 20 in July and 26 by August of that year. MGB said it could not validate those numbers, which leaders presented to doctors.
The company behind the analytics, Vizient, has hosted presentations and spoken in podcasts about increasing hospice enrollment to improve mortality performance.
A spokesperson from Vizient did not respond to requests for comment.
The physicians the Globe interviewed didn’t suggest patients were enrolled in hospice inappropriately. Doctors acknowledged inpatient hospice can help patients and families receive more support, even if the clinical care remains basically unchanged. But, they said, it wasn’t saving lives.
“This transition is laughably superficial,” the Brigham physician said. “It’s an administrative change, which doesn’t worsen the care for patients, but it is a sleight of hand.”
MGB contested the idea that increasing hospice use was a meaningful reason mortality scores had dropped. The health system declined to provide the share of hospital deaths in hospice over time, which some doctors alleged had increased, saying it was not a figure they tracked.
A general medicine doctor at Mass General Brigham agreed that integration or quality improvements resulting from it likely weren’t the leading reasons for the mortality drop. Beyond hospice enrollment, the physician pointed at more robust clinical documentation, also called coding, which increases expected mortality.
A 2022 internal presentation on coding outlined that Mass General Brigham had created a tool to mine its electronic medical record system for diagnoses. One of the benefits, the presentation outlined, was better mortality scores.
Such methods have been used elsewhere and been promoted by Vizient.
MGB executives acknowledged better coding helped mortality scores early on. But some physicians suspected it was playing an outsize role.
“Either they are stupid or they think we are,” the general medicine doctor said. “My joke was if integration is dropping inpatient mortality by [that much], it shouldn’t be just on the front page of the Globe, it needs to be above the masthead in the New England Journal [of Medicine]: the most life-saving change known to man.”
A fourth anonymous physician, who practices at MGH, said the figures seemed like more of a misleading marketing claim than the science-backed rigor that underlies the system’s medical work.
“The reason why it’s galling is because it’s the same thing happening in society — outrageous numbers are trotted out by people in positions of authority to advance their agenda,” the doctor said. “That’s the fundamental thing that is hurtful to all of us.”
An integration reason
Beyond the obvious imperative to save lives, Mass General Brigham executives noted that mortality metrics generally are important for other reasons, including that they are tied to reimbursements from federal and state government insurance programs. This aims to incentivize health systems to deliver quality care and not just high quantities of care.
Other health systems have tied these metrics to compensation. While Sisodia said she wasn’t privy to compensation structures of all MGB employees, employees were incentivized to deliver on these quality systemwide goals, of which a large component was the mortality ratio.
Executives said while they look at many figures, including actual deaths on each unit, the ratio was the best mortality metric the hospital has that takes into account how sick a patient is, and could be compared to other hospitals.
Leaders emphasized overall that clinicians were learning from their care to improve upon it.
“I know there’s people out there that love to say, ‘This is just hospice or gaming.’ It’s just not true,” Sisodia said. “And I know it’s an attractive story to say, because people don’t want to feel that we weren’t doing as good as we should have been before.”
More recently, Sisodia said, hospice enrollment across the system stayed flat from January to March, but MGB’s mortality ratio still fell from approximately 0.65 to 0.46.
One doctor pointed to the drop showing a return to normal after a seasonal flu spike, with little change compared to the prior year.
Some doctors suggest that MGB cares more about marketing around its efforts to bring its hospitals together.
In many of the notes celebrating the mortality stat, executives have pointed to the work integrating the system’s hospitals and teams, saying the quality improvements were evidence that integration had been effective. They say the health system now has a unified strategy, with everyone rowing in the same direction.
But for years, many clinicians have bristled at the shifts to a centralized system, feeling their voices have been pushed to the side in favor of more corporate decision-making. Among the controversial changes was an announcement in 2024 to combine clinical services across its flagship hospitals — a decision some say has created departments so large that physicians struggle to access leaders the way they used to. Integration also was partly the reason behind large-scale layoffs in 2025, which sources suggested affected approximately 1,500 people.
“MGB is invested in a narrative that the merger is helping everyone, and all this hard work is because patients are being helped,” the Brigham doctor said. “Without that narrative, with a lot of the very painful decisions being made, it’s harder to motivate employees.”
The general medicine doctor said MGB needs to focus more attention on its long wait lists for appointments.
“You are advertising all over the country for new patients. And you aren’t providing access to the patients you already have,” the doctor said. “That is very upsetting. When they say integration will be great — great for whom?”
The upset about the mortality stat reflected broader discontent with leadership. In a 2025 survey of health system employees, only half of respondents said they had faith in leadership — similar to a survey two years prior.
MGB is not unique in tracking this metric or broadcasting its success.
In fact, Dr. Eric Dickson, CEO of UMass Memorial Health, said all hospitals work to lower mortality scores.
But Dickson wasn’t publicly celebrating improvements as saving lives. He pointed to Harrington Hospital, where care didn’t change but the mortality ratio dropped from 2 to 0.5, after UMass acquired it and gave it technology to ensure all illnesses were properly documented.
Ultimately, Dickson said, mortality ratios are important metrics to judge hospitals by, in concert with other stats. Even though administrative changes can improve the scores, he said, they can’t be used to make a horrible hospital look amazing.
“You can only game [quality measures] so much,” Dickson said. “You can’t make chicken salad out of chicken poop.”
Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her @ByJessBartlett.