The Guardians are a workgroup of patients and patient safety advocates developed and led by PFPS US Patient Safety Champions.

The purpose of the Guardians is to inspire every hospital to authentically adopt the patient safety best practices identified in the PSSM and encourage trustworthy PSSM reporting.

The PSSM is a new hospital quality measure, adopted by the Centers for Medicare & Medicaid Services (CMS) in 2025.  Starting in 2026, the PSSM requires hospital leaders to annually “attest”—yes or no—to whether each of 25 patient safety best practices specified in the measure is in place at the hospital they lead.

The PSSM is a complement to patient safety outcome or process measures. Rather than focusing on specific clinical outcomes or quality improvement processes, the PSSM evaluates whether the foundational elements of a comprehensive patient safety program are in place. 

The PSSM best practices are grouped in 5 domains:

1. Leadership  Commitment to  Eliminating Preventable Harm
2. Strategic Planning and  Organizational Policy
3. Cultural Safety & Learning Health System
4. Accountability & Transparency
5. Patient & Family Engagement 

Results of hospital Attestation statements will be analyzed by CMS and scored by domain. To receive a point, a hospital must answer “yes” to all the best practices within a domain.  The maximum score a hospital can earn is 5. CMS will begin publicly reporting hospital scores, from zero to 5, starting in late 2026.

Successfully embedding PSSM best practices will require leadership, strategy, investment, and courage among hospital leaders.  It may take time for some hospitals to say yes to all 25 Attestations. Because their PSSM scores will be publicly reported, there will be pressure to “check the box” in a shortcut way without authentically implementing the PSSM best practices.

The Guardians seek to inspire hospitals to fully embrace the PSSM by producing real-life stories that illustrate why each best practice attestation is important.  We do this by contrasting what happened with what could happen:

My hospital did not have a PSSM best practice in place.  What if it had?  Would the harm I experienced have been different?

or

My hospital did have a PSSM best practice in place.  Would my experience have been different if it had not? What if other hospitals embraced the same PSSM best practice?