Safety in 2026: From fragile systems to Zero Harm 24/7

Safety in healthcare has always been complex. And that complexity has only compounded over time. The workforce is under more strain than ever, with increasing acuity and momentous technological change—demands that require more (and better) than infrequent, incremental improvement. What’s needed now is a fundamental shift in how safety is led, prioritized, and sustained. 

Using Press Ganey’s safety AI tools and healthcare expertise, we analyzed 870,733 safety events submitted to the Press Ganey Patient Safey Organization (PSO) by 194 health systems and 4,511 facilities between December 1, 2024, and November 30, 2025. One finding became impossible to ignore: Patient harm isn’t driven by isolated failures. Instead, it’s the result of persistent, system-level vulnerabilities—the same fragile processes, cognitive shortcuts, and communication breakdowns that surface year after year. 

But the data also points to a growing opportunity: When leaders align on a shared strategy, use data to both measure and learn, and build cultures where safety is everyone’s responsibility, zero harm stops feeling something far off.  

Familiar risks, deeper consequences 

Safety events remain highly concentrated. Just five event types—Care Management, Medication, Procedural, Delays in Diagnosis, and Falls—account for nearly 78% of all reported events. While rankings shift slightly from year to year, the consistency of these categories signals enduring system risks that require attention, not episodic fixes. 

Among Serious Safety Events, several trends are especially concerning: 

• Other Care Management events continue to dominate (29.39%), reflecting  

• Overuse of this catchall category for safety event classification. 

• Falls (14.27%) remain a leading source of serious harm, particularly among older adults. 

• Delays in diagnosis and treatment now account for 12.59% of Serious Safety Events, up from 9% last year—and are frequently associated with permanent harm or death. 

• Despite having the greatest share of Near Miss reports, Medication events to surface where systems depend too heavily on memory, assumptions, and individual vigilance. 

Until organizations redesign the systems that repeatedly fail, the same risks will continue to resurface—often with higher stakes. 

Serious harm is underreported and underestimated 

Serious Safety Events represent just 2.5% of harm-classified reports, yet that small percentage corresponds to more than 15,000 patients in a single year. And even that figure likely understates reality as underreporting is a widespread problem recognized by the patient safety industry. 

Near misses and precursor events offer obvious warning signals, but only if organizations create cultures where reporting concerns is nonpunitive, expected, and protected. Without psychological safety and trust, the most critical insights remain hidden, leaving leaders blind to systemic risk. 

Safety cannot be separated from equity 

Harm isn’t evenly distributed. African American/Black patients are overrepresented in diagnostic events, and even more so in those resulting in serious harm or death. They also experience Serious Safety Events at higher rates overall, not just within diagnosis-related failures.  

Safety patterns extend beyond race, with risk also concentrated at the extremes of age. Newborns experience a higher portion of diagnostic errors. Older adults face disproportionate risk from falls and fall-related harm. 

These disparities aren’t incidental, but serious indicators of deeper system failures. Safety can only be achieved when equity is embedded into how data is analyzed, how risks are prioritized, and how interventions are designed. Breakdowns aren’t isolated but reflect predictable points of failure in systems that aren’t yet designed for consistency under pressure.  

When systems fail, humans are set up to fail 

This year’s data offers insight into persistent breakdowns in monitoring, escalation, and communication—especially failures to recognize deterioration and respond reliably to changes in patient conditions.  

Cultural barriers, inconsistent workflows, and limited decision-support tools continue to compromise the reliability of even highly skilled teams. Physician ordering emerged as a critical point of vulnerability, representing the key activity associated with medical staff events. Knowledge gaps, assumptions, and normalized deviance are compounded by confusing order sets and insufficient EHR safeguards, resulting in delays, omissions, and miscommunications. 

Failures to validate and verify are increasing across both the individual and system level, reflecting environments where assumptions replace confirmation. 

Omitted actions and inadequate checks are now the most frequent system-level failures—especially in high-acuity areas like the operating room. 

Reducing harm requires building processes that make the right action the default action—supported by standardized workflows, strong checks, and psychological safety. 

Accelerating toward Zero Harm 24/7 

From boardrooms to the bedside, safety must become the foundation of how organizations lead, operate, and provide care. That belief is at the heart of Zero Harm 24/7, a leadership-led safety movement we launched earlier this year. Zero Harm 24/7 challenges organizations to shift their outlook on safety from a “delegated responsibility” to a board and executive imperative.  to a board and executive imperative.  

At its core are 10 Critical Commitments aligned with the CMS Patient Safety Structural Measure—clear, actionable responsibilities that embed safety into culture, strategy, and operations. These commitments expand how we define harm, addressing physical and emotional safety, strengthening partnerships with patients and families, fostering a fair and transparent culture, and prioritizing proactive risk reduction over retrospective review. 

It’s not about adding more work to already stretched teams, but changing how work is designed, so safety becomes reliable, repeatable, and sustainable. 

The Press Ganey Patient Safety Organization supports this transformation through comparative analysis, AI-driven insights, safety alerts, expert guidance, and peer learning. These capabilities are powered by one of the largest patient safety datasets in the country, which now totals more than 7 million safety events.  

This year’s PSO report reinforces that safety is not the result of intention but that of leadership, system design, and learning in action.  

For more on these findings, download the 2026 Press Ganey PSO executive summary. To learn more about joining the Press Ganey PSO, contact Heather Reed, PSO Director, at hreed@pressganey.com.