Zero Harm 24/7: A bold commitment to safer care—every day, everywhere

By Dr. Tejal Gandhi, Carole Stockmeier, and Kerry Butler

In an era of unprecedented advancement in healthcare, the fundamental promise to “do no harm” remains as critical as ever. Yet, preventable patient harm continues to pose a significant threat across care settings and shifts, undermining public trust, increasing costs, and, most importantly, affecting the lives of far too many.

When it comes to safety, zero harm is the only acceptable goal. When we aspire to zero harm, we set a clear, collective intention for what care can and should be, for everyone, everywhere. The goal isn’t perfection; it’s direction. Zero harm is a compass, not a metric. The second you replace it with “as low as reasonably possible,” you give permission to stop trying when it gets uncomfortable. Zero harm keeps you honest. It is the very source of your organization’s integrity. It forces leaders to feel the weight of every shortcut, every workaround, every time production beats protection.

From the boardroom to the bedside, we must always put safety first as the very foundation of how we lead, care, and connect. That’s the vision behind Press Ganey’s Zero Harm 24/7 industry collaborative—a commitment to ensure safety is a shared core value that drives strategy and operations. This work calls on boards and executive leaders to anchor healthcare best practices that ensure safety is embedded into the work we do every day and across the entire care continuum.

And it starts now.

Grounding safety as a leadership imperative

Zero Harm 24/7 invites healthcare organizations to think differently. It challenges us to elevate safety from a delegated responsibility to a board and executive imperative. It asks: What could we achieve if safety were led at the highest levels and woven into every aspect of our culture, our operations, and care delivery?

The 10 Commitments: A blueprint for meaningful change

Zero Harm 24/7 recognizes the pivotal role of governance and executive leadership in driving system change and elevating patient safety to the highest levels of strategic planning, resource allocation, and performance oversight. At the heart of Zero Harm 24/7 are 10 Critical Commitments, designed for boards and CEOs—actionable leadership responsibilities and strategies (aligned with the CMS Patient Safety Structural Measure) that will overcome barriers and accelerate progress toward zero harm.

Top 10 barriers ​to Zero Harm 24/7​

1. Boards assume that healthcare is safe, and CEOs delegate the responsibility for safety.​
2. Safety is treated as a project and exists as silo.​
3. We know and tolerate variation in operations, within organizations and across the industry.​
4. We permit and even promote wide variability in leadership knowledge, skills, and behaviors.​
5. We don’t measure safety well.​
6. We undervalue the input of patients and families.​
7. We are blind to harm other than physical harm.​
8. We are reactive, not proactive.​
9. When events occur, we still blame and shame, and we let lawyers deny and defend.​
10. We don’t learn from failures nor successes, and we don’t improve.​

Critical Commitments ​of the board and CEO​, aligned with the CMS Patient Safety Structural Measure​

1. Establish and visibly demonstrate safety as a core value.​
2. Drive safety integration across the organization.​
3. Require a high reliability operating system to ensure that performance is as intended consistently over time.​
4. Require consistent leadership structures and behavior expectations to drive safety performance.​
5. Optimize safety measurement and monitoring.​
6. Partner with patients and families to embed their input into all levels of safety strategy.​
7. Ensure both physical and emotional safety of patients and workforce across the care continuum.​
8. Focus strategy on identifying and mitigating risks and harm.​
9. Require a fair, just, and transparent culture.​
10. Require learning from failures and successes, driving a culture of continuous improvement.​

It’s time to lead with urgency, clarity, and purpose—to build healthcare systems where safety is not an aspiration, but a guarantee.

Zero Harm 24/7 is not about adding more work. What it is about, is changing how we work, as leaders, creating the conditions where safety is truly embedded and continuously improved.

Aligning vision with action

To support participating organizations, Press Ganey will provide a strong infrastructure for learning and improvement. Our solutions that support this initiative include:

• Best-in-class safety practices and solutions
• PSO safety event alerts and event detection assessments
• A comprehensive patient listening bundle, from surveys and rounding to digital focus groups
• A peer learning network to accelerate shared progress

One objective: Zero Harm 24/7

This is a moment of immense possibility. By coming together around our shared commitment, we can shape a future where safety first and zero harm is a lived reality for every patient and every member of every care team.

To learn more about Zero Harm 24/7, reach out to our team here. Because zero harm is a journey we take together—listening, learning, and supporting one another, as we build a safer, more equitable system.