New Press Ganey Research Provides Full Picture of Workforce Safety Concerns

By Jay Kumar

New research released by Press Ganey finds that night-shift healthcare staff are three times more likely to witness workplace violence and four times more likely to experience it themselves.

The State of Healthcare Safety 2026, based on 2025 data from 1.3 million healthcare employees and more than 23 million patients, explores how workforce culture, reporting behaviors, and leadership alignment influence safety performance and care reliability across health systems.

“I love putting this report together because it pulls from so many different data sources that we have at Press Ganey,” says Tejal Gandhi, MD, Chief Safety and Transformation Officer at Press Ganey. “Honestly, I don’t think any other organization has the breadth and depth of safety data that we have.”

The new report consolidates several different sources of patient safety and quality data collected by Press Ganey, she adds.

“It really came together with this idea of, ‘Let’s look at our data in safety, but also really understand the intersections of safety with other areas like employee engagement, like patient experience, etc., and bring it all under one report.’ And so we did that,” Gandhi says. “And so if you look at the data in there, there’s safety culture data from the largest benchmarking database in the country. There’s data from our event reporting system around organizational learning and how well we’re learning from events. There’s data from the National Database of Nursing Quality Indicators, which is safety outcomes data like CLABSIs and CAUTIs and falls, but also workforce violence data. So we have the workforce safety piece as well as the patient safety piece. And then there’s data of course from patient experience around patient perceptions of safety.”

There are several takeaways from the data, Gandhi notes.

“Around safety culture, I think of it as a glass half-empty, glass half-full story. The glass half-full is a good story. We are seeing trends of improvement and really across all the questions in the instrument, which is awesome. Last year we had plateaued after the improvements post-COVID, so I was a little concerned last year that are we going to just stay plateaued, but we are seeing improvements. So I think that’s a really important point,” she says.

“The glass half empty side of that story is 46% of the respondents around the country still have a low perception of safety culture and so that’s a huge opportunity. I guess instead of saying glass half-empty, we can say opportunity because we know safety culture correlates with engagement, with turnover, with safety outcomes, etc. This is such an opportunity that we need to continue to improve and I think we need to do it faster. We’re sort of improving at a very slow pace and yet we have this big swath of the workforce that still needs to see that. So that’s one big takeaway for me.”

Learning from adverse events is another important measurement in the report.

“Another one is for the first time in our industry we have put out benchmarks around how do you effectively measure how well you learn. So we’ve seen organizations track their event rates like we have a serious safety event rate or we have 10,000 safety events a year that get reported in,” says Gandhi. “But we haven’t been measuring what are you doing with those reports and how effectively are you learning. And we have some really interesting data in the report around how if you effectively learn, it correlates with stronger safety culture, with higher rates of reporting and with better patient experience outcomes.

“And so this idea of the learning system, which has been around for a long time in healthcare, but of how we measure it and actually drive performance in it is where we’re really trying to push the industry. And so you’ll see in the report a whole section that lays out types of measures that we’re tracking and benchmarks for those measures because we have enough organizations using our system that we can actually say, ‘OK, here’s what the benchmark for the industry is around some of these things.’”

Gandhi said examples include “things like anonymous reporting rates, which is kind of a proxy around your safety culture or the things that I get really jazzed about are how well are you getting to strong actions when you are doing your event analysis. How often are you providing feedback back to the reporter about improvements that have happened? And you can measure that, which directly ties to performance on certain areas of your safety culture survey. It’s a big report, there’s a lot of data, but in terms of kind of new, never-been-shown-before types of things, I think that is a really exciting component. And then the third big new innovative thing that we did I think is in the past we’ve shown safety culture data and been able to segment it by things like race, ethnicity, gender, even generation. Last year, we talked about millennials having lower perceptions of safety culture compared to other groups.”

Day and night

This year, Press Ganey focused on the perception differences between shifts.

“The look of days versus nights was really powerful because we found that night shift had lower perceptions of safety culture universally compared to day shift. And that was regardless of how experienced you are because the rationale might be, ‘Oh, those are younger nurses.’ But even if you’re a more seasoned nurse, for example, you have a lower perception if you work nights versus days. So that was one big thing,” Gandhi says.

“And then that night shift is more likely to experience violence, which is not surprising. And if you experience violence, your safety culture and your engagement are lower. So these like connections of workforce and patient safety, but also that look at the night shift. Because as we think about high reliability and performing as intended consistently over time with our high reliability principles and practices, the question that needs to go out to the industry is: Are we performing in a highly reliable way 24/7, 365? Because we might be doing certain things on days, which is great, but we’re a 24/7 industry and we have to make sure those things are happening across the board.”

The study found that 46.6% of respondents had a low perception of safety culture, but Gandhi believes progress is being made.

“By doing that more integrated approach across silos, that would help because then you’re not having these disparate initiatives, but one major set of initiatives that will be more impactful. So I think the answer is yes, we’ve got to improve our approaches to this,” she says. “We’ve got to improve our leadership engagement around it as well, but the segmentation piece is key because really understanding in your organization which groups are not feeling it and going deep into what is it that they need. And it might be different things, like what we did for the Gen Z’s or the Boomers may not be what we need for the millennials and understanding what it is that they need is just going to be critical. We are improving, bottom line, and I don’t want to downplay that because I think we always have to celebrate the positives and it could have been a totally different story.”

Safety culture and staff retention

Improving safety culture can help with staff retention, notes Gandhi.

“We’ve looked at it and we definitely have data around safety culture correlating with engagement and safety culture correlating with retention. And if you look at some of the strongest predictors of retention, safety items are, if not at the top, very close at the top.”

Having that data is important for making the case to leadership that safety culture is crucial, she says.

“Showing the direct cost benefits of preventing harm is unfortunately challenging, Gandhi says. “Absolutely we want to reduce harm to patients, but if you do this, you will retain your staff, which we know can create more hard dollars related to that.”

The workplace violence problem

Press Ganey’s latest analysis includes trends from the National Database of Nursing Quality Indicators that reveal increases in reported assaults on nurses, says Gandhi.

“What I can’t tell you is how much of that is more assaults and how much of that is more reports of assaults. Because I do think compared to 10 years ago, there’s much more attention on this area compared to 10 years ago,” she says. “The rates are increasing too, which is why there’s more attention. So I think we’re getting more reports because culturally now it’s not so much the norm of, ‘Oh yeah, that just happens.’ I think people are reporting more.”

To address the issue, healthcare organizations need to consider violence as part of a bigger picture of workforce safety.

“I always like to push organizations to take a little bit of a step back in the sense of let’s think about it as workforce safety and workforce violence is a piece of it because we know that even if you took violence out of the equation, healthcare is more dangerous than industries like mining, manufacturing, or construction,” Gandhi says.

“So we have to think about physical safety as the violence piece plus all of the back injuries, slips, trips, falls, needlesticks, all that stuff. We have to think about it all comprehensively in a workforce safety strategy and using the same sort of safety and high reliability principles we use for patient safety. So really integrating workforce safety and patient safety, thinking about: Are you doing root cause analysis, are you getting the strong actions, are you looking for themes, trends, all the things so it’s not like a one-by-each approach for the workforce stuff and then a more comprehensive approach for patient safety. Doing it all with that same methodology is really critical to get at those root causes, etc.”

Download the State of Healthcare Safety 2026 report here.