The Patient Safety Organization Program: Key barriers impeding nationwide progress toward reducing patient harm in hospitals (16 September 2025)

Summary

This report by the Office of Inspector General at the US Department of Health and Human Services looks at the implementation of the Patient Safety Organization (PSO) programme in the United States. Its findings suggest that although the PSO has helped some hospitals and health systems improve, it has fallen short in facilitating patient safety learning and improvement on a national scale.

Content

Key findings are highlighted below.

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