By Christopher P. Landrigan, MD, MPH, Co-Founder, I-PASS Patient Safety Institute; Chief of General Pediatrics, Boston Children's Hospital; William Berenberg Professor of Pediatrics, Harvard Medical School

As healthcare organizations prepare for a new era of accountability in patient safety, the Centers for Medicare & Medicaid Services (CMS) Patient Safety Structural Measure (PSSM) program is bringing unprecedented visibility to the systems and cultures that support safe care. Beginning in October 2026, CMS will publicly report hospital PSSM scores on the Medicare Care Compare website, allowing patients, families, healthcare leaders, and regulators to see how organizations are putting patient safety infrastructure into practice.

Adopted in fiscal year (FY) 2025, the PSSM is an attestation-based measure organized around five foundational domains: leadership commitment, strategic planning and organizational policy, culture of safety and learning, accountability and transparency, and patient and family engagement. Hospitals attest to whether they have established the practices outlined within each domain, earning one point toward their measure performance score for every area met. Developed by safety experts, hospital leaders, researchers, and patient advocates, the PSSM is designed to assess not just whether an organization values patient safety, but whether the structures, policies, and processes needed to support it are in place.

The public reporting of these scores marks a significant shift in how healthcare organizations demonstrate their commitment to patient safety. Beginning with the FY 2027 payment determination, hospitals participating in the Hospital Inpatient Quality Reporting (IQR) Program will be required to report on the PSSM or risk a reduction in their annual Medicare payment update, making patient safety infrastructure not only a clinical priority but also a financial and strategic imperative.

That is where I-PASS has a direct role to play. Communication failures during transitions of care remain a major source of preventable harm, and I-PASS is designed to address that risk by giving care teams a standardized, evidence-based framework for exchanging critical patient information. In recognition of World Patient Safety Day 2026, the I-PASS Patient Safety Institute is examining how structured handoff communication can help hospitals strengthen their patient safety infrastructure while supporting success across multiple CMS PSSM domains.

Why Communication Matters for PSSM Readiness

Over the past 20 years, countless studies have found that communication failures during transitions of care are a leading cause of harmful medical errors and malpractice claims. Analyses from the Joint Commission have found that miscommunications are a root cause of 50–80% of all sentinel events, the most severe adverse events in hospitals. Likewise, Candello’s analyses of the Comparative Benchmarking Database, a national database of malpractice claims, have found that miscommunications lead to over half of all claims. Because these failures occur across healthcare settings and involve every type of clinician, handoffs represent both a significant source of risk and a practical opportunity for organizations to strengthen the systems that support safer care.

The I-PASS handoff methodology addresses this challenge through a structured communication framework that promotes consistency, clarity, and accountability. It gives care teams a common language for care transitions, ensuring that vital patient information is communicated accurately and completely. Research from the I-PASS Study Group found that I-PASS implementation reduces harmful medical errors by 30–47% across a wide range of hospitals, with a growing body of evidence also showing benefits to patient experience, safety culture, and hospital efficiency. By improving both the reliability of communication and the broader culture around patient safety, I-PASS can help hospitals make meaningful progress across several areas measured by the PSSM.

Supporting CMS Domain 1: Leadership Commitment to Eliminating Preventable Harm

The first PSSM domain focuses on whether hospital leaders actively prioritize patient safety and invest in systems that reduce harm, emphasizing the importance of leadership engagement in establishing safety as a core organizational value.

Implementing I-PASS demonstrates a tangible commitment from leadership to improve care coordination and reduce communication-related errors, as successful adoption requires executive sponsorship, organizational resources, staff training, and ongoing measurement of compliance and outcomes. This visible investment signals to CMS that patient safety is not merely an aspiration, but an operational priority embedded within organizational strategy and the day-to-day activities of frontline clinicians.

Supporting CMS Domain 2: Advancing Strategic Planning and Organizational Policy

CMS's second domain evaluates whether patient safety is incorporated into organizational planning, policies, and workforce development. To meet this foundational area, hospitals are expected to establish systems and competencies that support safe care delivery across the organization.

I-PASS supports this objective by providing a standardized approach to handoff communication that can be incorporated into organizational policies, onboarding programs, and clinical workflows. Rather than relying on individual communication styles or unit-specific practices, organizations create a system-level process that reinforces best practices and promotes reliability throughout the continuum of care.

Supporting CMS Domain 3: Strengthening a Culture of Safety and Learning

Beyond the policies and systems that support safe care, the PSSM also looks at whether patient safety is embedded in the day-to-day culture of the organization. According to CMS, communication training and learning systems are key components of a mature safety culture, encouraging continuous improvement and stronger collaboration.

I-PASS directly supports this domain by teaching clinicians structured communication techniques and promoting shared accountability during handoffs. The framework emphasizes active listening, asking questions, and establishing confirmation of understanding, behaviors that strengthen interdisciplinary collaboration while creating opportunities for learning and improvement. As organizations monitor handoff performance and outcomes, these techniques generate valuable data that can inform future patient safety initiatives.

Supporting CMS Domain 4: Enhancing Accountability and Transparency

The fourth CMS domain focuses on accountability and transparency in safety practices. To earn a point in this area, healthcare organizations must demonstrate that they have processes in place for identifying risks, monitoring performance, and addressing opportunities for improvement.

I-PASS contributes to accountability by establishing clear expectations for communication during care transitions. Organizations can measure adherence to standardized handoffs, evaluate performance trends, and identify areas requiring additional support or education. By giving organizations a consistent way to evaluate how handoffs are being performed, I-PASS helps them pinpoint gaps, track progress, and make targeted improvements.

Supporting CMS Domain 5: Supporting Patient and Family Engagement

Patient and family engagement is increasingly recognized as a critical component of patient safety. CMS includes this as a core PSSM domain because patients and families often identify risks and opportunities that healthcare teams may overlook. For healthcare organizations, the challenge is translating that principle into consistent opportunities for patients and families to participate in the care process.

Although I-PASS began as a framework for clinician-to-clinician communication, it has been successfully adapted for use in clinician-to-patient and family communication as well. Patient and Family Centered I-PASS adapts the structured I-PASS framework to family-centered rounds, using plain language, two-way communication, and active patient and family participation to help ensure everyone understands and contributes to the plan of care. Studies of the program have found improvements in patient safety, patient and family experience, and engagement.

I-PASS can also support patient and family participation through bedside shift report, where nurses conduct handoffs at the bedside and invite patients and families to contribute. With a deliberate pause for patient input built into the standardized bedside handoff, patients and families become active participants in the exchange. This creates another opportunity to surface questions, concerns, or information that might otherwise be missed while strengthening communication across the care team.

A Strategic Opportunity for Hospitals

With public PSSM reporting beginning in October 2026, hospitals have a clear opportunity to assess whether their patient safety priorities are translating into reliable practice. The measure should not be viewed solely as a reporting requirement, but as a framework for identifying where stronger systems, processes, and accountability may be needed.

I-PASS offers a practical way to turn those priorities into action and demonstrate a clear commitment to patient safety and high reliability. By standardizing communication during high-risk care transitions and giving organizations a consistent way to train teams, measure performance, and reinforce safer behaviors, I-PASS helps make patient safety more actionable at the point of care. As expectations around patient safety continue to rise, the organizations best positioned for success will be those that use the PSSM as a catalyst for lasting improvement.

Preparing for PSSM reporting? Contact us to learn how I-PASS can help translate patient safety priorities into measurable, reliable practice.