Resources by the CMS Patient Safety Structural Measure Domains
The Patient Safety Structural Measure is an attestation-based measure to assess whether hospitals demonstrate having a structure and culture that prioritizes patient safety. The Patient Safety Structural Measure is informed by the National Action Plan and includes five domains that contain multiple statements aiming to capture the most salient structural and cultural elements of patient safety. The five domains and illustrative elements are presented below.
- Domain 1: Leadership Commitment to Eliminating Preventable Harm:
- Executive leadership oversees organizational safety self-assessment.
- Domain 2: Strategic Planning and Organizational Policy:
- Commitment to “zero preventable harm.”
- Implementation of patient safety competencies for all staff.
- Action plans are in place to improve workforce safety.
- Domain 3: Culture of Safety and Learning Health System:
- A hospital-wide culture of safety survey is conducted.
- Implementation of team communication training.
- Participation in large-scale learning networks for patient safety.
- Domain 4: Accountability and Transparency:
- Use of a communication and resolution program.
- Domain 5: Patient and Family Engagement:
- Patient and Family Advisory Council (PFAC) provides input on safety.
Additional information about the measure includes measure specifications, an attestation guide, and a quick reference guide. The tools and resources presented on this page may support hospitals in achieving affirmative attestation to statements within a domain.
Contents
- Domain 1: Leadership Commitment to Eliminating Preventable Harm.
- Domain 2: Strategic Planning and Organizational Policy.
- Domain 3: Culture of Safety and Learning Health System.
- Domain 4: Accountability and Transparency.
- Domain 5: Patient and Family Engagement.
Domain 1: Leadership Commitment to Eliminating Preventable Harm
Commitment to Advance Patient and Workforce Safety
The National Action Alliance for Patient and Workforce Safety enables executive leaders to commit to its aims: performing an organizational safety self-assessment and implementing a safety plan that addresses identified gaps, empowering the patient's voice, strengthening safety competencies for all team members, better engineering safety into practice, and collaborating when it comes to safety. Committing to the aims of the National Action Alliance may help demonstrate that the governing board and hospital leaders prioritize safety as a core value.
National Action Plan to Advance Patient Safety Self-Assessment Tool
This system-wide assessment tool, when overseen and/or implemented by hospital leaders and executives, can be used to evaluate organizational practices and capacity, and to track the progress of safety improvement over time.
Veterans Health Administration (VHA) Patient Safety Assessment Tool
Hospital leaders and executives can implement and/or oversee the use of this tool to conduct an objective assessment of their patient safety program, including evaluating organizational safety practices and capacity. The tool is organized by six program elements and includes a list of questions and rationale for assessment.
Domain 2: Strategic Planning and Organizational Policy
AHRQ Comprehensive Unit-based Safety Program (CUSP) Method
CUSP is a patient safety curriculum to help clinical teams make care safer by combining improved teamwork, clinical best practices, and the science of safety. The Core CUSP Toolkit includes training resources and tools to apply the CUSP methods and build capacity to address safety issues. Additional toolkits offer resources and guidance for preventing hospital acquired infections: catheter-associated urinary tract infection (CAUTI); central line-associated bloodstream infection (CLABSI); CLABSI and CAUTI in intensive care units (ICUs); MRSA in hospital intensive care units (ICUs) and non-intensive care units (non-ICUs); antibiotic stewardship; mechanically ventilated patients in ICUs; and surgery and surgical care and recovery.
The Patient Safety Competencies Affinity Group conducted an environmental scan to identify 12 fundamental, industry-standard safety competency domains and their specific associated themes. Hospitals can use these themes as a framework for assessing their implementation of and/or developing action plans associated with patient safety competencies for all clinical and non-clinical staff.
AHRQ SOPS® Hospital Workplace Safety Supplemental Item Set
The SOPS® Workplace Safety Supplemental Item Set for hospitals is used with the core SOPS® Hospital Survey to help hospitals assess the extent to which their organization's culture supports workplace safety for providers and staff. Hospitals can use the findings from the survey to identify workforce safety trends, and the available resource list (PDF, 277 KB) can be used to support action planning for workforce safety, including improvement activities.
Hospitals can use this workbook to guide efforts to conduct a baseline self-assessment, develop an action plan with steps to improve based on current status, and measure progress on the use of interventions aligned with the CDC’s Total Worker Health approach to improving workers' safety, health, and well-being.
This guide supports executive leaders in developing action plans to address workforce safety, including ensuring both a safe work environment and psychological safety. The guide offers six evidence-informed actions and provides supporting tools and resources.
Occupational Safety and Health Administration (OSHA) Worker Safety in Hospitals
This collection of resources can inform a hospital’s action plan for workforce safety. The resources include the How Safe is Your Hospital? and the Safe Patient Handling self-assessment tools to better understand how safe the workplace is and how it measures up against other hospitals. Additional resources present information and strategies to support worker safety action and improvement.
Domain 3: Culture of Safety and Learning Health System
AHRQ National Action Alliance for Patient and Workforce Safety
Hospitals can participate in the National Action Alliance, which is a national patient and workforce safety learning network for all healthcare settings and roles. Among its activities, the National Action Alliance hosts webinars, offers implementation opportunities in patient and workforce safety, and provides a curated list of tools and resources with best practices that hospitals can implement to improve safety outcomes and decrease adverse events.
AHRQ Patient Safety Indicators
AHRQ’s Patient Safety Indicators (PSIs) provide information on potentially avoidable safety events that can be used to measure and track safety performance and outcomes. The PSIs include measures for potential in-hospital complications and adverse events following surgeries, procedures, and childbirth.
AHRQ Surveys on Patient Safety Culture® (SOPS®) Hospital Survey and Additional Resources
The SOPS Hospital Survey is a validated survey that provides a hospital-wide assessment of culture of safety from the perspective of providers and staff. Hospitals can use the additional resources including improvement resources, case studies, and tools for data entry and analysis and strategic planning to inform unit-based interventions to reduce harm.
AHRQ TeamSTEPPS® 3.0 (Team Strategies and Tools to Enhance Performance and Patient Safety)
TeamSTEPPS 3.0 is an evidenced-based team communication and collaboration training that teaches tools and strategies focused on leadership, situation monitoring, mutual support and communication. Implementation of the tools and resources can improve teamwork, safety culture, and patient safety outcomes.
AHRQ TeamSTEPPS® for Diagnosis Improvement
The TeamSTEPPS for Diagnosis Improvement Course applies the TeamSTEPPS framework to the specific problem of diagnostic error. This team communication and collaboration training aims to raise diagnostic safety awareness, introduce the concept of a broad multidisciplinary diagnostic team that includes nonclinicians and patients and their families, and provide assessment and training tools to support local efforts to reduce diagnostic harm. The course consists of seven training modules customizable to the needs of the local team and course facilitator.
Domain 4: Accountability and Transparency
AHRQ CANDOR (Communication and Optimal Resolution) Toolkit
CANDOR is a communication and resolution program that provides hospitals with the tools to respond immediately when a patient is harmed and to promote candid, empathetic communication and timely resolution for patients, caregivers, and the healthcare organization.
AHRQ Patient Safety Organizations (PSOs)
This information supports hospitals seeking to enhance patient safety and quality improvement activities by voluntarily working with a PSO. AHRQ provides guidance on how to choose a PSO and maintains a list of current PSOs.
Domain 5: Patient and Family Engagement
AHRQ Guide for Developing a Community-Based Patient Safety Advisory Council
This guide provides information and guidance for hospitals to build a patient safety advisory council that involves patients, consumers, practitioners, and professionals from health care and community organizations. The guide presents 10 steps for creating the council, with descriptive examples to illustrate their implementation.
AHRQ Guide to Patient and Family Engagement in Hospital Quality and Safety
This guide helps hospitals identify and engage patients and families to improve quality and safety as advisors in a council or committee. It includes an implementation handbook and tools for patients, families, and clinicians.
AHRQ Improving Healthcare Safety by Engaging Patients and Families (PDF, 578 KB)
This resource summarizes 53 AHRQ-funded projects to improve patient safety by supporting increased patient and family engagement.
