In a defining moment for patient safety, the Centers for Medicare and Medicaid Services (CMS) recently introduced the Patient Safety Structural Measure (PSSM), designed to assess how well hospitals have implemented strategies and practices to build a safety-based culture and systems. Set to take effect beginning with the January-December 2025 reporting period, the new attestation-based measure incentivizes leaders of acute care hospitals to evaluate how they prioritize patient safety across five domains, including leadership commitment, strategic planning and organizational policy, culture of safety and learning, accountability and transparency, and patient and family engagement.
Alongside reporting and public transparency incentives, annual attestation enables hospitals to identify and address opportunities for strengthening their systems-based foundations for safety to ensure safe, equitable, and person-centered care.
Communication breakdowns are a leading driver of patient safety failures and span every care area. This is apparent during unstructured patient handoffs, where miscommunication between clinicians can result in serious or fatal medical errors. Because seamless care transitions are essential to quality care delivery, standardizing communications is an efficient way for hospitals to meet the requirements for several elements of the five PSSM domains.
Domain #1: Leadership Commitment to Eliminating Preventable Harm
To enhance care coordination and improve collaboration between care teams at scale, hospitals need an efficient, reliable, and consistent communication framework. The I-PASS Patient Safety Institute provides clinicians with an evidence-based solution for conducting structured handoffs, improving communication between care teams, and reducing preventable harm. As the gold standard solution to standardize care transitions, the I-PASS bundle allows hospitals to assess capabilities, advance safety, and demonstrate safety as a core value.
I-PASS provides a shared, unified structure for verbal and written handoff communication—helping institutions train their staff, monitor adherence, and offer ongoing education. Alongside a suite of evidence-backed tools designed to build and monitor competency in structured handoffs, I-PASS ensures that patient safety finds its way into the very fabric of an organization. From day one, a Coaching and Implementation Team guides the process—helping to parlay adoption and sustainability through an overarching people and culture-campaign. At every level of an organization, I-PASS gives hospitals the tools to conduct effective, reliable communication.
Domain #2: Strategic Planning and Organizational Policy
I-PASS provides a structured and standardized curriculum for patient safety and quality improvement across an organization. By implementing training, education, and feedback processes to support handoff communication, hospitals signal a public commitment to patient safety and achieving zero preventable harm. I-PASS includes the observational tools and record-keeping capabilities to monitor structured communication competencies with data and metrics. Detailed reports provide insight into process adherence and outcomes, allowing clinicians to find opportunities for continuous improvement in handoff communication.
In particular, the I-PASS Written Handoff tool provides a valuable companion document that enables the seamless implementation of written policies and protocols. Optimizing within existing EHRs, this system of I-PASS templates and design solutions enables hospitals to continuously monitor, track, and address both workforce and patient safety.
Domain #3: Culture of Safety and Learning Health System
Structured communication is relevant to every clinical role across the healthcare system. To facilitate a culture of safety and learning, hospitals require a suite of evidence-based practices that enable continuous education. I-PASS works with hospitals to understand their unique environment through a needs assessment, trains clinicians and observers to implement structured written and verbal handoffs and provides adherence and outcome metrics to identify areas for continuous improvement.
For hospitals on a high reliability journey, I-PASS opens pathways for optimizing safety and eliminating preventable harm. With I-PASS, hospitals can facilitate both intra- and inter-organizational learning and initiate and develop systems to facilitate interprofessional education and training on safety. Through the I-PASS GME Program, organizations can train residents in structured communication, ensuring they enter the workforce with the tools and educational backing to successfully utilize a standardized system of communication. By investing in structured communication, hospitals can develop shared goals for safety across the continuum of care.
Domain #4: Accountability and Transparency
In the realm of accountability and transparency, I-PASS can facilitate consistent and ongoing progress toward zero preventable harm by enabling continuous assessment and improvement throughout the implementation process and beyond. Using the structured framework, clinicians can observe and provide feedback on live handoff sessions, monitoring program adherence and related outcomes. Care teams can align on shared goals, track collective progress, and sustain a positive culture change—opening an actionable and ongoing channel for identifying, addressing, and eliminating errors.
Domain #5: Patient and Family Engagement
These pathways for structured communication enable patients and their families to engage in crucial care conversations, exchange information with clinicians, and play an active role in the treatment process as designated members of a safe care team. Designed to provide patients, families, and caregivers with the agency and oversight to participate in meaningful quality improvements, this domain encourages participation in safety activities such as bedside rounding and discharge planning—both of which I-PASS supports. A 2018 study demonstrated that the implementation of a co-produced family-centered communication program, which included the use of the I-PASS structure during rounds, led to a 38% reduction in harmful errors. Patient and Family Centered I-PASS employs structured methods for highly reliable communications to facilitate effective care conversations between patients, clinicians, and families.
To satisfy the patient and family engagement domain, hospitals must unite patients, families, and caregivers as “coproducers of safety and health.” I-PASS can help hospitals establish competencies for clinicians’ engagement of patients, families, and care partners—and, in doing so, encourage productive, mutually beneficial communication throughout the treatment process.
With the new PSSM, hospitals can drive meaningful change and steward long-lasting system-level improvement ensuring all patients receive safe and quality care. As January approaches, it’s time for hospital leaders to implement the I-PASS bundle, cementing their commitment to prioritize patient safety.