The Centers for Medicare & Medicaid Services (CMS) have introduced the Patient Safety Structural Measure (PSSM) as part of their FY 2025 Hospital Inpatient Prospective Payment System (IPPS) rule. This initiative shifts the focus from traditional patient safety metrics, such as incident rates, to assessing the structural and cultural foundations that help prevent harm before it occurs.

Designed to help hospitals foster a proactive, safety-first culture, the PSSM framework is built around five key domains, each essential to advancing safer care environments.

What is the Patient Safety Structural Measure (PSSM)?

The CMS PSSM framework represents a new era in patient safety, emphasizing the importance of having robust structures and systems in place. While past safety metrics often focused on outcomes—like falls or infection rates—the PSSM takes a foundational approach. By examining leadership, policies, culture, and accountability, this measure helps hospitals proactively identify and mitigate risks.

For more information on what the PSSM is, refer to our blog 'What is the Patient Safety Structural Measure Framework (PSSM)' here.

The PSSM is relevant for all hospitals participating in CMS's Hospital Inpatient Quality Reporting Program, with reporting requirements starting in 2025. Public scores will be published in 2026, making transparency a focal point for safety performance.

For more information on how your organization can best prepare for implementing the upcoming changes, watch the recording of our webinar 'Preparing for the CMS Patient Safety Structural Measure with lessons learned from the UK' here.

The five domains of the Patient Safety Structural Measure (PSSM)

At the heart of the Patient Safety Structural Measure are its five key domains, each addressing critical aspects of patient safety. Together, they form a roadmap for hospitals to build safer, more resilient systems. Below, we provide a brief overview of each domain.

To explore the 25 attestation statements that accompany each domain in more detail, read our Guide to the Patient Safety Structural Measure (PSSM) Framework, here.

Domain 1: Leadership commitment to eliminating preventable harm

Strong leadership is the foundation of any robust patient safety initiative. This domain focuses on senior leaders' accountability in integrating patient safety into strategy, operations, and decision-making. It emphasizes transparent communication, adequate resource allocation, and leadership involvement in safety initiatives.

Learn more about how technology supports compliance with leadership-focused initiatives in our blog on PSSM Domain 1, 'How leaders shape safer healthcare: understanding PSSM Domain 1', here.

You can also watch our webinar 'PSSM Domain 1: Leadership commitment to eliminating preventable harm' exploring leadership strategies to work towards achieving zero preventable harm.

Domain 2: Strategic planning and organizational policy

Embedding safety into your hospital’s strategic plans and policies is critical. Domain 2 evaluates hospitals on their ability to create a just culture that encourages reporting and learning from errors. It also prioritizes setting clear safety goals, such as achieving zero preventable harm, and implementing regular training programs for staff.

Discover how to integrate safety into strategic planning in our blog, 'PSSM D2: Zero preventable harm goals: turning aspirations into measurable outcomes'

You can also access proven methods in our webinar 'PSSM Domain 2: Embedding patient safety into strategic planning and organizational policies' focused on organizational policies.

Domain 3: Culture of safety and learning health system

Building a culture of safety goes beyond words—it’s about creating an environment where staff feel empowered to report risks, learn from events, and engage in continuous improvement. Domain 3 promotes tools like safety culture surveys, root cause analysis (RCA), and high-reliability practices to reduce harm and drive learning.

Dive into actionable strategies by exploring our Domain 3 blog 'How technology supports compliance with PSSM Domain 3: culture of safety and learning in healthcare' here.

You can also take a look at our PSSM Domain 3 webinar PSSM Domain 3: Building a health system culture based on safety and a learning in healthcare.

Domain 4: Accountability and transparency

Hospitals that operate transparently and hold themselves accountable build trust with patients, staff, and the broader community. Domain 4 evaluates hospitals on their use of confidential reporting systems, involvement with Patient Safety Organizations (PSOs), and public reporting of safety metrics.

Uncover how digital tools enhance processes in our blog How technology drives compliance with PSSM Domain 4: accountability and transparency in patient safety' on PSSM Domain 4

You can also watch our webinar 'PSSM Domain 4: How to achieve productive transparency and accountability for patient safety compliance' and learn tips from real-world leaders in our webinar on accountability and transparency

Domain 5: Patient and family engagement

Patients and families are essential partners in safety initiatives. Domain 5 examines how hospitals involve patients and caregivers in decision-making, safety planning, and policy creation. Practices like forming Family Advisory Councils and empowering patients to review their records help create safer environments.

Read more about PSSM Domain 5 in our blog Patient Safety Structural Measure (PSSM) Domain 5: Driving safety through patient and family engagement.

You can also watch our full webinar recording PSSM Domain 5: Patient and family engagement in safety.

Next steps for implementing the Patient Safety Structural Measure (PSSM) framework

Implementing the PSSM framework may feel like a complex task, but it’s achievable with the right approach. Here’s how your organization can prepare:

1. Conduct a readiness assessment. Compare current practices against the PSSM domains to identify any gaps.
2. Develop a strategic action plan. Set clear priorities, allocate resources, and establish timelines for addressing gaps.
3. Leverage technology. Use tools like incident reporting platforms, dashboards, and integrated systems to track progress and simplify compliance.
4. Engage stakeholders. Foster buy-in from senior leadership to frontline staff, emphasizing the shared responsibility of patient safety.
5. Monitor progress. Regularly evaluate advancements and refine your strategies based on measurable outcomes.

For a deeper understanding of these reporting requirements and how to prepare for them, explore our whitepaper 'Preparing for the 2025 CMS Patient Safety Structural Measure (PSSM) reporting requirements' whitepaper on preparing for the 2025 CMS Patient Safety Structural Measure (PSSM) reporting requirements.

The CMS Patient Safety Structural Measure (PSSM) framework offers a unique opportunity to build safer, more reliable healthcare systems. Position your organization as a leader in patient safety. For more information on the PSSM app from Ideagen InPhase, take a look at our Patient Safety Structural Measure (PSSM) app datasheet here.

Closing thoughts

The Patient Safety Structural Measure marks a pivotal shift in advancing patient safety across the healthcare industry. By focusing on leadership, culture, accountability, and engagement, the PSSM provides a blueprint for creating lasting change.

For more information on how Ideagen InPhase can support your work with the Patient Safety Structural Measure, schedule your time with an expert today.