In defense of zero harm: Why healthcare needs impossible goals in 2025

I understand why some in healthcare remain skeptical of the concept of “zero harm.” Early in my career as a physician, I too found the idea implausible—an unrealistic ambition in the face of our health system’s immense complexities.

But 20 years in patient safety have changed my perspective. Over time, I’ve come to recognize that zero harm isn’t unrealistic—it’s aspirational. As someone deeply committed to practical, operational solutions, I certainly believe a great idea only holds value if it can be implemented. Yet, while “only a little harm” may sound more pragmatic, it doesn’t drive the kind of transformative change our industry needs.

What I’ve learned is that setting a seemingly impossible goal like zero harm doesn’t block us—it challenges us. It pushes us to think differently, to innovate beyond what we believe is possible, and to make patient and workforce safety a true core value. Aiming for zero harm forces us to move beyond incremental improvements and instead reimagine our entire approach.

A roadmap for safer care

When I co-led the National Steering Committee for Patient Safety and its development of the National Action Plan for Patient Safety, zero harm was our focus and North Star. The plan outlines core strategies for enhancing patient and workforce safety—everything from leadership commitment to safety culture to patient engagement.

I also contributed to the development of the Patient Safety Structural Measure as a member of the Technical Expert Panel that advised CMS. This measure represents a critical shift in how hospitals are assessed—not just by their outcomes, but by whether they have the necessary structures and processes in place to prevent harm before it happens. By incorporating key principles from the National Action Plan, this measure ensures that hospitals nationwide are not only striving for zero harm, but systematically equipped to achieve it.

The goal was never about marginal reductions in harm. It was always about eradicating it altogether. That mindset shift is what has allowed this plan to become a cornerstone for leading institutions nationwide. By framing safety through the lens of zero harm, we set a higher bar and have inspired progress that wouldn’t be possible with more conventional, incremental goals.

Safety starts with transparency

One of the most counterintuitive aspects of zero harm is that achieving it requires acknowledging when harm occurs. Just 25 years ago, the idea that doctors could make mistakes was almost taboo. The expectation of perfection led to a culture where errors went unreported, ultimately putting both patients and caregivers at greater risk.

Healthcare workers who experience errors firsthand can suffer from second victim syndrome—a psychological response to being involved in an adverse event. The impact can be profound. Fear of failure leads to underreporting, decreased confidence, and, in some cases, talented professionals leaving the field entirely.

To address this, we must normalize learning from errors, not punishing them. When I was CEO of the National Patient Safety Foundation, I saw firsthand how litigation concerns prevented hospitals from openly sharing safety data. Recognizing the need for change, federally protected Patient Safety Organizations (PSOs) were created by legislation, which enable organizations to share data without fear of legal consequences. These initiatives foster the psychologically safe environments that help advance us towards zero harm.

Zero harm as a catalyst for progress

Critics argue that zero harm is demoralizing—an unattainable standard in an ever-evolving healthcare landscape. I see it differently. When framed effectively, it becomes a powerful motivator. It acknowledges human fallibility while driving us to create systems that prevent errors from causing harm. And when we talk about zero harm, it includes physical and emotional harm to our patients and workforce across the continuum of care.

This is what patients expect. It’s what our workforce deserves. Safety isn’t just a priority—it’s the foundation of healthcare. If you aren’t safe, nothing else matters.

The pursuit of zero harm is not about achieving perfection. It’s about relentless progress. It’s about designing safer systems, fostering a culture of transparency, and ensuring that every patient and caregiver can trust that healthcare is as safe as possible.

We’ve made strides, but our work is far from over. The journey continues, and I remain as committed as ever to pushing the boundaries of what’s possible in patient and workforce safety. Zero harm is an aspiration. We may never fully reach it, but in striving for it, we create the conditions for excellence and the safest possible care.