• Safety culture is a leading indicator of workforce stability. Seven of the top 10 national key drivers of employee engagement are related to safety culture, placing it among the strongest engagement drivers in the industry.
• Active reporting means higher performance. Facilities that report safety events at or above the expected rate in the Press Ganey High Reliability Platform™ are more than 8x as likely to rank in the top quartile for employee–manager collaboration, learning from mistakes, teamwork within units, and perception of care quality.
• Strong learning systems and reporting cultures reinforce one another. Organisations that excel in cause analysis rigor and action plan strength are more likely to sustain robust reporting environments, creating a virtuous cycle of visibility, accountability, and progress.
• Social capital is the connective tissue that brings everything together. Social capital is the force multiplier behind safety performance. Organisations that lead on employees’ responses to questions about respect and teamwork are 3x more likely to achieve top-quartile patient loyalty scores and 50–80% more likely to excel on key safety outcomes.
• Safety suffers when a single organisation operates as three hospitals under one roof. Many organisations struggle with consistency of experience depending on shift resulting in what seems to employees and patients like three hospitals under the same roof. Staff perceive safety culture differently and patient experience of care varies based on shift—day, night, or weekend. This variance between days vs. nights and weekends can lead to more safety events and patients feeling less safe.
• Learnings come from the Patient Safety Organization (PSO). Learnings from the Press Ganey PSO can be leveraged to understand how and when harm occurs across the industry based on trending data. The members of the PSO gather insights from the more than 190 health system partners and 7.1 million patient safety event records in its national database.

Several other topics highlight persistent obstacles—such as emergency department boarding and medication safety vulnerabilities in packaging and labelling design—that continue to strain the healthcare system.

A few topics featured this year include:

• Reduced access to rural healthcare increases health risks and disparities.
• Increasing rates of preventable acute diseases.
• Effects of federal funding cuts on healthcare operations and patient safety.

To effectively understand where vulnerabilities lie, leaders must examine all elements of their systems—people, organisations, tasks and processes, tools and technology and the physical environment. Each topic in this year’s Top 10 represents a failure in one or more of these interconnected areas.

From the United States

1. Diagnostic errors and delays: why quality investigations are key

Dan Cohen, international consultant in patient safety and clinical risk management, and Trustee for Patient Safety Learning, looks at the challenges around diagnostic error and delay,

3. A complex adaptive systems approach to patient safety

Kumar Subramaniam, CEO at SafeTower, argues that it is time to reimagine safety event reporting and management solutions that guide, not prescribe, investigations and improvement actions.

4. Patient Safety Spotlight interview with Soojin Jun, Co-founder of Patients for Patient Safety US 

Soojin Jun talks explains how her personal experience of harm motivated her to work in healthcare and campaign for patient safety, the power of collaboration in improving healthcare safety and how healthcare workers can take steps to improve their own patient interactions.

5. Harmful attitudes towards gynae surgery as a discipline – a risk to patient safety 

An interview with US-based gynaecology surgeon Jocelyn Fitzgerald, looking at the knock-on patient safety issues caused by negative attitudes towards her specialty.

6. Enhancing patient safety through effective communication in clinical trials and cancer care: a blog by Tambre Leighn

Tambre discusses how effective communication is essential for ensuring patient safety in clinical trials and cancer care, and why poor communication can lead to negative outcomes.

7. Now is not soon enough: Patients, families and the general public have much to gain from the US National Patient Safety Board Act

Olivia Lounsbury, Committee Lead for Patients for Patient Safety US's National Patient Safety Oversight committee, looks at a new Bill calling for the creation of a US National Patient Safety Board (NPSB).

From Africa

1. The 'Minutes of the Minute': a blog by Ehi Iden - OSHAfrica

Ehi Iden discusses the importance of documenting and learning from patient safety incidences. Using a fictional story to draw parallels from, Ehi highlights how accountability, leadership and reporting incidences will help us keep staff and patients safe.

2. Friends of African Nursing (FoAN): Training perioperative nurses across Africa

FoAN's Chair of Trustees Kate Woodhead describes the challenges facing nurses working in perioperative care in many African countries.

3. 'Mind the Implementation Gap': the challenges facing Ethiopia

Yakob Seman Ahmed reflects on Patient Safety Learning's recent report 'Mind the implementation gap: The persistence of avoidable harm in the NHS' and the similar challenges Ethiopia faces in implementing its own standards and policies.

4. Patient Safety Spotlight interview with Chidiebere Ibe, medical illustrator and medical student

Chidiebere Ibe is passionate about increasing representation of Black people in all forms of medical literature. In this interview, he explains how lack of representation at all levels of the healthcare system leads to disparities in healthcare experiences and outcomes.

5. Spotlight on Sudan: How can we improve healthcare services during war? 

From his observations of healthcare conditions in Sudan, Dr Ahmed Khalafalla presents some ideas on how we can improve healthcare services during times of war and uncertainty to make healthcare services accessible for those who need them.

6. Preventing patient falls in healthcare settings: The need for fall risk assessment

Patient falls are a significant concern in healthcare settings, often leading to severe injuries, prolonged hospital stays and increased healthcare costs. This blog from Augustine Kumah, Deputy Quality Manager at The Bank Hospital, Accra, Ghana, explores the significance of fall risk assessment, its implementation and its role in reducing fall-related incidents in healthcare settings.

7. Putting patients at the centre of antimicrobial stewardship in Uganda: Why meaningful patient engagement is essential to beating antimicrobial resistance

Across Uganda, patients are increasingly experiencing infections that no longer respond to commonly used antibiotics. Conditions that were once easily treatable now require longer hospital stays, repeated courses of treatment and higher out-of-pocket expenditure. In this blog, Annet Naguudi, Regina Kamoga and Joshua Wamboga from the Uganda Alliance of Patients’ Organizations (UAPO) argue that strengthening AMS in Uganda requires placing patients at the centre of the response and highlights the strategic positioning of the UAPO to lead this shift in line with national and global priorities.

From Australia

1. #NavigatingHealth—Enabling every patient, every time, system-wide

In this blog, Siân Slade shares how, through her research interest into the difficulties of navigating the healthcare system in Australia, she created a policy and advocacy project: #NavigatingHealth. The aims of the project are to streamline the silos and address the fragmentation of healthcare by bringing together all those who are developing solutions to enable patients and carers to better navigate healthcare journeys. 

2. “Listening to a patient’s history for longer can help doctors make the right diagnosis”

Mary Dahm and Carmel Crock tell us more about their research to explore the relationship between communication and diagnostic accuracy.

3. Professional regulation and patient safety systems: parallel planets or partners in improvement?

Martin Fletcher has been part of transformational change in professional regulation through his tenure as Chief Executive of the Australian Health Practitioner Regulation Agency (Ahpra). Martin shares Australia's regulatory journey and reflects on the UK's more gradual path to reforming their legislative frameworks. He highlights both countries' shared common goals and the challenges faced along the way. He ends the blog with three priorities for future action: integrating professional regulation into system safety, better use of data to anticipate risk and embedding equity and cultural safety.

More international insights…

1. ‘Knowledge is the driver of change and will make a difference': a blog from Peter Lachman

Peter, Lead of the Faculty Quality Improvement Programme, Royal College of Physicians of Ireland, explains why safety must be embedded into what we do every day, not what we do only after harm has occurred, and why we need to constantly ask ourselves “what do we need to do to be safe?”

2. Patient Safety Spotlight interview with Isabela Castro, patient advocate

Isabela is from Brazil and in this interview shares how her experience of losing her baby daughter to avoidable harm in 2006 led to her involvement in patient safety advocacy, and talks about the vital role of patient campaigners in driving the movement to reduce avoidable harm.

3. Patient Safety Spotlight interview with Roohil Yusuf, Global Pharmacy Adviser at Save the Children international

Roohil talks to us about the vital role of pharmacists in making sure medications help patients, rather than causing harm and highlights the global threat of substandard and counterfeit medicines.

4. Mother knows best – a blog by Dr Abha Agrawal

Dr Abha Agrawal shares with the hub her family's experience of going into hospital in India, and demonstrates how patients and families can be true partners in patient safety.

5. The patient's chair: a blog by Dr Faisal Saeed

Dr Faisal Saeed, a doctor in the Maldives, talks about the patient-provider power imbalance using an AI generated image of two chairs to illustrate his points.

6. Patient Safety Spotlight interview with Josie Gilday, Global Medical Adviser at Save the Children International 

Josie tells us about the nursing error that first sparked her interest in patient safety, how a just culture helps healthcare workers and systems learn from their mistakes, and how her love of skiing has inspired her to think differently about risk in healthcare.

7. Treading around level 3: Time for a paradigm shift in patient safety?

Dr Abdulelah Alhawsawi, Abdominal Organs Transplant and Hepato-biliary Surgeon, and Director General of the Saudi Patient Safety Center, discusses why hospitals are falling short of safe care levels. He believes healthcare continues to be structurally weak when it comes to the safety conditions and suggests that there is an urgent need for a paradigm shift in the way we think about patient safety and how we implement it while providing healthcare. In his essay, Dr Alhawsawi proposes four practical solutions.

8. The power of being heard in healthcare (a blog by Risa Mallory)

Risa Mallory, a retired psychotherapist from Canada, talks about the importance of listening in healthcare, and how patient voices play a critical role in ensuring safety, quality and fairness.

9. Patient safety in humanitarian settings

This blog describes the challenges faced in assuring patient safety in humanitarian settings and offers suggestions for how international medical aid organisations can build patient safety systems.

10. How a charity in France is supporting intensive care units: An interview with Anne-Sophie Debue

In this interview, Anne-Sophie Debue tells us about the 101 Fund in France, a charity that develops projects to support intensive care units, and a tool that they have developed, LifeMapp, which supports patients and their families during and after intensive care. 

11. Can systems modelling help generate safer and faster morbidity and mortality conference preparation? Reflections from a pilot study on coronary angiography

Stefan Peil, a healthcare consultant in Germany, summarises a pilot study he has done to see whether a structured systems model can support the preparation of a morbidity and mortality (M&M) conference discussion.

12. The ant that moves the elephant: a lesson in building safer reporting cultures

Saed Saleh Abed, a risk management supervisor at the Royal Commission Health Services Program (RCHSP) in Jubail, Saudi Arabia, discusses how a single report—no matter how minor—can challenge an assumption and shift an entire system toward safer care.

Join the hub

Do you have insights to share around patient safety? Are you a member of the hub? Why not join our global community today (it’s free and easy to sign up) and submit an article or share a resource? You can also contact the editorial team at content@pslhub.org.

Could you be an international Topic leader for the hub?

We are looking for someone based outside of the UK, with expertise in an area of patient safety to join our team of volunteer Topic leaders. 

Our topic leaders are an integral part of ensuring the value of content on the hub. We want to ensure that quality content is published on the hub and that we have credible experts in specific topic areas to

• contribute personal blogs sharing expertise and insights
• advise us on the validity of posted content
• suggest areas to develop content in
• lead and respond to discussions within our communities.

If you’d like to apply to become a topic please visit our Topic leader page where you’ll find a job description and application form.

Hospital and health system leaders across the country are already bracing for the financial impact of the One Big Beautiful Bill Act that President Donald Trump signed into law on 4 July, anticipating reductions and closures at their organisations. The legislation includes more than $911 billion in Medicaid spending reductions over 10 years, achieved through work requirements, added administrative hurdles and limits on state funding mechanisms, with the effects on hospitals and health systems varying by state.

2. Expiration of enhanced ACA subsidies

With ACA enhanced premium subsidies set to expire at the end of the year, millions could lose affordable coverage, leaving hospitals to shoulder a larger burden of uncompensated care.

3. Medicare Advantage pressures

Medicare Advantage now covers more than half of the nation’s older adults, but its rapid expansion has brought mounting tensions with hospitals and health systems. In recent years, an increasing number of providers have opted to end or not renew contracts with certain MA insurers, citing excessive prior authorisation hurdles, slow reimbursement timelines and rising administrative burdens.

Hospital leaders say these issues have moved beyond inconvenience and are now threatening financial stability. 

4. 340B Drug pricing program changes

Hospitals have long relied on savings generated from the 340B drug pricing program to offset the cost of care for low-income and uninsured patients. But recent shifts from drugmakers and HHS are putting that financial lifeline under new pressure.

In July, CMS proposed accelerating a clawback of $7.8 billion in outpatient drug payments tied to reimbursement cuts imposed on 340B hospitals between 2018 and 2022. After the Supreme Court ruled in 2022 that those cuts were unlawful and hospitals were repaid, CMS moved to offset the cost of those repayments by reducing future payments for non-drug items and services.

5. National Institutes of Health (NIH) research funding cuts

Medical schools, teaching hospitals and other research institutions are bracing for sweeping changes to reimbursements for indirect costs that support research projects. In February, the NIH said it plans to cap the amount of funding research institutions receive for indirect costs — which help cover laboratory space, equipment and other overhead expenses — at 15%. In past years, the average rate was between 27% and 28%. Research institutions have said the policy would significantly hinder research activity, limit access to clinical trials and stall scientific progress on groundbreaking treatments.

In response to these findings, the Office of Inspector General recommends:

1. Increase alignment of the PSO program with other Department of Health and Human Services patient safety efforts
2. Promote opportunities to involve patients and families in PSO activities
3. Clarify cybersecurity protections and data use limitations for patient safety work product submitted to the Network of Patient Safety Databases
4. Take steps to harness technologies and new data sources that could help address barriers facing the Network of Patient Safety Databases

• 30% of Oregonians have had experience with medical harm in the last 5 years; this includes direct experience of harm or harm experienced by someone close to them.
• Oregonians expect transparency about medical harm—more than 9 in 10 of those surveyed agreed that healthcare providers should be required to tell patients if a medical error is made during their care.
• Oregonians want to be informed right away about medical harm, and they want an apology for what happened; however, only 31% of Oregonians who experienced harm got this type of response from the healthcare provider or facility.
• The more serious the health consequences of the harm, the less likely Oregonians were to be informed or to get an apology.

• Full implementation of hospital and insurer price transparency.
• Creation of a “mental health diagnosis and prescription working group” to review prescription patterns, potential harms and “over-prescription trends,” which will include new research and updated drug labels.
• Collaboration with states on prior authorization requirements and prescribing safeguards “to address the overuse of medications in school-age children—particularly for conditions such as ADHD”.
• New quality metrics centred on health outcomes as well as Medicaid managed care quality metrics “that promote measurable health improvements through nutrition coaching and other fitness indicators”.
• A new “vaccine framework” that focuses on vaccine injuries, transparency, “correcting conflicts of interest and misaligned incentives” and “ensuring scientific and medical freedom”.
• A National Institutes of Health (NIH) chronic disease research initiative that takes a whole-person-health approach to prevention.
• The creation of a real-world data platform at NIH linking data sources such as insurance claims, EHRs and wearables data.
• Leveraging the NIH’s longitudinal birth cohort data for chronic disease research and prevention.
• Expanded use of New Approach Methodologies (NAMs) at the NIH, the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA).
• Promoting direct primary care model use with health savings accounts, as well as enrolment for those on high-deductible health plans.
• Increased enforcement and oversight of direct-to-consumer pharmaceutical advertising—which was also cemented in a memorandum signed by President Donald Trump,
• Leveraging HHS funding toward community health programmes and partnerships.
• Requirements that HHS advisory committee members recuse themselves for financial conflicts of interest,
• New research into “the root causes of autism,” results from which HHS leaders previously said could come this year (with recent reports suggesting Tylenol use during pregnancy will be named as a potential cause).
• Public databases on the payments received by health researchers, "similar" to [the Centers for Medicare and Medicaid Services’] Open Payments system for physicians.
• The creation of the Administration for a Healthy America, which would take several responsibilities around chronic health from the Centers for Disease Control and Prevention (CDC).
• The launch of a new Office of Research Innovation, Validation and Application at the NIH, which will focus on shifting away from animal testing in favour of advanced techniques such as organoids, computational models and real-world health data analysis.
• The development of a new Office of Research Innovations, Planning and Analysis at the NIH, focused on disease-specific portfolio analysis and research prioritisation.
• Review participation in any projects funded by food or pharmaceutical companies through the CDC Foundation, Foundation for the NIH or the Reagan-Udall Foundation.
• Policies at the NIH limiting open access payments to scientific journals.
• Promoting nutrition in medical school curriculum.
• Supporting new medical education programme accreditors, “including those with a focus on treating the root causes of chronic disease”.
• Various educational programs on topics like screen time, paediatric mental health, fitness, pesticide review processes and “the appropriate levels of fluoride”.

https://www.facebook.com/watch/?v=1285590883210650

Hospitals did not capture all OIG-identified patient harm events, nor investigate all harm events they did capture, limiting hospitals’ ability to make improvements for patient safety.

Hospitals did not capture half of patient harm events that occurred among hospitalized Medicare patients. In many cases, staff did not consider these events to be harm or explained that it was not standard practice to capture them. This was often because hospitals applied narrow definitions of harm.

Of the patient harm events that hospitals captured, few were investigated, and even fewer led to hospitals making improvements for patient safety. Some of the improvement actions hospitals took in response to the harm events included training staff and enhancing monitoring for similar events.

What OIG Recommends

HHS leads national efforts to promote patient safety. The findings demonstrate that more Federal leadership is needed to drive and sustain progress. We recommend that AHRQ and CMS work with Federal partners and other organisations to align harm event definitions and create a taxonomy of patient harm to drive a more comprehensive capture rate of harm events. The report recommends that CMS ensure that surveyors prioritise the Medicare Quality Assurance and Performance Improvement (QAPI) requirement to hold hospitals accountable for patient harm.

The QAPI requirement is intended to ensure that hospitals deliver safe, quality care and prevent patient harm. Finally, we recommend that CMS instruct Quality Improvement Organisations to use information about harm events to assist hospitals in identifying weaknesses in their incident reporting or other surveillance systems.

Speaker: Dr. Candan Kendir, OECD

Dr. Kendir introduced the methodology and results of the first PaRIS survey cycle, which gathered data from over 107,000 patients and 1,800 practices in 19 countries. She highlighted key findings around access, care continuity, self-management support, and patient trust — and made the case for why family doctors are essential to the success of the next survey cycle.

Webinar 2: Patient Reported Outcomes and Experiences in Slovenia and Czechia

Speakers: Prof. Zalika Klemenc-Ketiš, Prof. Bohumil Seifert, Viviana Martinez-Bianchi M.D.

This session examined why Slovenia and Czechia performed strongly in the PaRIS survey despite moderate health spending. The presenters explored how strong family medicine systems, long-term continuity, and high patient trust contributed to excellent outcomes and experiences — with reflections on how these lessons may be relevant in other contexts.

Webinar 3: Measurements behind Patients’ Voices: PROMs and PREMs in OECD PaRIS

Speaker: Prof. Jose Maria Valderas, Chair, WONCA Working Party on Quality and Safety

Prof. Valderas unpacked the scientific framework behind PaRIS, including the survey’s development process, validated measures (such as PROMIS-10 and the WHO Well-being Index), and the OECD’s “PaRIS 10” indicators. He shared insights into cross-country variations and highlighted future efforts to expand the survey into low- and middle-income countries.

On 27 March  HHS announced massive restructuring and the firing of 10 000 employees, including many career scientists. On 16 May, the flagship Make America Healthy Again report was published—it was later found to contain numerous misrepresentations and alleged AI-based hallucinations.

On 27 May Kennedy announced changes to the recommendations for COVID-19 vaccination via social media, reportedly bypassing usual scientific committees and presenting no new evidence to justify the changes.

On 9 June, he dismissed all 17 members of the independent Advisory Committee on Immunization Practices (ACIP) as well as officials tasked with vetting members and overseeing the group. He later made controversial appointments of his own choosing.

On 7 July, measles cases in the USA reached their highest levels in 25 years. On 0 July, Kennedy abruptly cancelled a meeting of the US Preventive Services Task Force, an expert panel that evaluates preventive care recommendations. Meanwhile, the proposed federal budget for 2026 calls for a 40% reduction in funding for the NIH and a 54% reduction for the CDC. And, as reported in the Lancet, the One Big Beautiful Bill Act will see 17 million people lose health insurance. The promise has been to tackle chronic disease, address undue corporate influences, and make all Americans healthier, but the dissonance between rhetoric and action shows deep contradiction and hypocrisy at the heart of US health leadership.