Beginning in October 2026, CMS is making PSSM scores public for the first time, giving patients and other stakeholders a new view of how hospitals support patient safety.
The PSSM is a CMS tool that assesses whether hospitals have the organizational structures, leadership practices, and processes in place to support patient safety. Acute care hospitals that participate in the Hospital Inpatient Quality Reporting Program are required to report on PSSM. Beginning in October 2026, hospitals’ PSSM performance will be publicly reported, making their patient safety practices and structures visible to patients and other stakeholders.
Rather than tracking outcomes like infection rates or readmissions, PSSM looks at the infrastructure behind those outcomes. That includes the policies, governance, accountability systems and commitments that shape how an organization prevents harm. In short, it asks whether the foundation for safe care is in place.
Performance is scored from zero to five, with one point available for each domain. Each domain uses an all-or-nothing structure. A hospital must attest to every criterion within a domain to earn that point, so partial progress doesn't count toward the score. This approach rewards hospitals that have built comprehensive, well-documented safety structures rather than isolated initiatives.
According to the National Healthcare Safety Network, PSSM is organized around five domains. Each represents a distinct part of a hospital's safety infrastructure, and together they reflect how completely an organization supports safe patient care. Understanding each domain on its own terms helps leaders pinpoint where they're strong and where work remains.
This domain looks at whether senior leaders and the governing board are visibly accountable for patient safety. It evaluates whether safety is a standing priority in governance discussions, whether leaders receive timely information about serious safety events, and whether that commitment shows up in resourcing and decision-making. The core question is whether safety is led from the top.
This domain evaluates whether a hospital has a defined patient safety strategy built into organizational policy. That strategy should set measurable goals, address known risks —including workforce safety concerns like falls and workplace violence — and be reviewed and updated regularly. A strong plan turns good intentions into documented, repeatable practice.
This domain looks at whether hospitals foster an environment where safety events are discussed openly and staff can raise concerns without fear. It also evaluates whether the organization measures its safety culture and uses what it learns to prevent future harm. A learning health system treats every event as a chance to improve.
This domain evaluates how hospitals create accountability for safety performance and share information openly with staff, patients, and the public. It includes how events are reported, how confidential reporting is supported, and how safety data is used to drive improvement. Transparency helps build the trust that sustained improvement depends on.
This domain looks at whether patients and families are active partners in safety. It evaluates whether hospitals have formal structures for patient and family input, such as a patient and family advisory council, and whether patients have access to the information they need to take part in their care. When patients are included, safety efforts reflect the full care experience.
Understanding the domains is only the starting point. For most hospitals, the harder work is identifying where current practices fall short of full credit in each domain. These common challenges map directly to the five domains.
Without clear ownership, safety initiatives can stall when priorities shift. Hospitals that make progress here typically name specific leaders accountable for safety, give the board regular visibility into safety performance, and set clear expectations for how quickly serious events are escalated. Consistent leadership attention keeps safety from becoming a once-a-year conversation.
Many hospitals treat patient safety as a departmental function rather than an organizational priority. Building safety goals into strategic plans and formal policy takes sustained effort, not just a committee charter. Workforce safety belongs in this plan too, since a safe environment for staff supports a safe environment for patients.
Reporting and investigation processes create value only when findings lead to action. Hospitals often struggle to close the loop between identifying an event and applying the lesson across departments. A learning culture depends on staff seeing that their reports lead to real change.
Tracking incidents is not the same as understanding trends. Hospitals need reliable data practices to determine whether their safety efforts are reducing harm, and they need clear ways to share that information with staff and the public. Transparency works best when data is timely, accurate and tied to improvement goals.
PSSM reporting reflects a broader shift toward greater organizational visibility and accountability. HealthStream’s 2026 research found that 43% of organizations exchange data across business applications, illustrating how healthcare leaders are increasingly relying on connected systems and enterprise-wide information to support oversight, performance monitoring, and continuous improvement.
HealthStream research found that 43% of organizations exchange data across business applications, supporting the enterprise-wide visibility needed to drive accountability and improvement.
Communication gaps between care teams and patients can weaken even well-designed safety programs. Meaningful engagement goes beyond satisfaction surveys. It means giving patients and families a formal voice in safety planning and making it easy for them to raise concerns.
According to the Agency for Healthcare Research and Quality (AHRQ), research shows that when patients are actively engaged in their healthcare, organizations can achieve measurable improvements in both safety and quality. This reinforces the role of patient and family participation as an important component of a comprehensive safety reporting and improvement strategy.
According to AHRQ, research shows that actively engaged patients can improve safety and quality outcomes, highlighting the value of patient and family participation in safety improvement efforts.
Training is one of the most practical tools hospitals can use to address gaps across all five domains of the PSSM. Education helps turn policies into everyday practice. Several connections stand out.
Consistent, organization-wide training helps every staff member understand current safety protocols, regardless of department or shift. Shared expectations make it easier to apply policy the same way across the organization.
Ongoing education, including continuous learning, keeps safety practices active in daily routines. That's more effective than material staff learn once during onboarding and rarely revisit.
Regular competency assessments help hospitals confirm that staff can apply safety protocols correctly, not just recall them. Verified competency gives leaders greater confidence in healthcare workforce readiness.
When event reviews or culture assessments surface a gap, targeted training is often one of the fastest ways to address it. Learning becomes a direct response to what the organization discovers.
Education programs tied to quality improvement data give hospitals a clearer picture of whether training is changing behavior and outcomes. This connection supports the learning health system approach the measure encourages.
Hospitals preparing for PSSM reporting can start with a few concrete steps. Because each domain is scored all-or-nothing, a domain-by-domain review is the most reliable place to begin.
The goal is a continuous improvement process, not a one-time compliance effort. Hospitals that revisit these steps regularly are better positioned to hold their scores over time.
For chief quality officers and patient safety leaders, PSSM reporting adds new visibility to work that has traditionally happened behind the scenes. Public reporting means that an organization's safety infrastructure, not just its outcomes, becomes part of how patients and referring providers may evaluate a hospital.
PSSM scores themselves won't directly change Medicare reimbursement. However, hospitals in the Hospital Inpatient Quality Reporting Program that don't submit required data, including PSSM attestations, may receive a reduction to their annual Medicare payment update. Together with public reporting, that gives quality leaders a clear reason to treat PSSM as a current priority.
PSSM also offers something beyond compliance. Its five domains provide a structured way to evaluate whether leadership, strategy, culture, transparency and patient engagement are working together. Hospitals that use the measure as a genuine self-assessment, rather than a checklist, are better positioned to turn structural compliance into a lasting safety culture.
HealthStream works with hospitals to support ongoing learning and competency development, helping safety initiatives stay active well beyond a single reporting cycle. A practical next step is to complete a domain-by-domain review of your current safety structures and use what you find to guide your education and improvement priorities.
The PSSM is a CMS measure that evaluates whether a hospital has the organizational structures and processes in place to support patient safety. It focuses on safety infrastructure rather than measuring clinical outcomes directly.
PSSM measures a hospital's safety infrastructure across five domains. Hospitals earn one point per domain, for a total score of zero to five, and must meet every criterion within a domain to earn its point.
The five domains are leadership commitment to eliminating preventable harm, strategic planning and organizational policy, culture of safety and learning health system, accountability and transparency, and patient and family engagement.
CMS will begin publicly reporting PSSM scores on Medicare's Care Compare website in October 2026.
Hospitals can prepare by assessing current structures against each of the five domains, identifying the specific criteria they haven't fully met, assigning clear accountability and building ongoing monitoring and learning processes.
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