Making cognitive safety standard care

We’re leading the first initiative to address cognitive harm  in health care — an urgent research and action program to improve outcomes, advance equity, and address one of healthcare’s most overlooked drivers of waste. 

The initiative aims to make cognitive safety a measurable standard of care through research, education and actionable tools; calling on health systems, clinicians, and academic partners to act now. By investing in cognitive safety, organizations can reduce harm, restore trust, and achieve measurable improvements in both patient outcomes and cost efficiency.

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Defining a hidden risk in healthcare

Cognitive harm is the preventable disruption of a patient’s ability to understand, trust, and engage with care. It happens when information is overwhelming, support is lacking, or communication leaves patients feeling isolated. The result: confusion, disengagement, and poorer outcomes—even when clinical care is technically correct.

Background on harm reduction

The harm reduction movement reshaped public health by centering on empathy and human context over blame. Cognitive harm reduction draws inspiration from that ethos, expanded to apply to a different frontier: medical care. 

Ending cognitive harm starts with shared responsibility. Patients, clinicians, and systems each play a role in restoring trust and improving outcomes.
This is one of the most overlooked, and most powerful, levers in strengthening health equity. 
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A patient feels frustrated that her symptoms are not being heard by her doctor. Her hands express her frustration and illustrate cognitive harm in clinical care.
“Cognitive harm isn’t rare, it’s almost universal. Everyone I have ever asked their experience, has shared at least one story of cognitive harm during the course of their medical care. It happens when efficiency pressures overtake empathy, and care becomes something done to patients instead of with them. We all pay the price of this gap in care: patients decline, clinicians burn out, and insurance companies absorb the cost.” ~ Cali Wilson

Cognitive safety starts with awareness

Categories

Defining cognitive harm
Why it matters
Equity & system cost

Cognitive harm is a hidden risk in healthcare, often overlooked but deeply impactful. It occurs when patients are left confused, overwhelmed, or unsupported in making sense of their care. This can happen even when treatment is technically correct, leading to disengagement, poorer outcomes, and higher costs for everyone involved.

Addressing cognitive harm means prioritizing clear communication, emotional safety, and patient understanding. When people feel heard and supported, trust grows, adherence improves, and recovery is more likely. Cognitive safety is not just a benefit—it's essential for quality care.

Social factors like health literacy, language, and systemic bias can intensify cognitive harm. By recognizing and reducing these barriers, we move toward more equitable, effective care. The cost of inaction is high, but together, we can set a new standard for cognitive safety in medicine.

Addressing cognitive harm is vital to quality care

Measuring cognitive harm in healthcare settings is essential.

While medicine has long focused on preventing physical harm, cognitive harm — remains overlooked, and worsens outcomes.

Patients often arrive already overwhelmed and without the support to process complex health information or participate fully in their care. Even skilled clinicians can’t overcome that alone.

Further, when patients are dismissed, invalidated, or made to question their own experience, trust breaks down.

The result? They disengage, skip appointments, and abandon treatment plans. These actions are often labeled as "non-compliance" failing to acknowledge and address the role clinicians and organizations play.
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"There is currently no framework integrated in medicine to measure cognitive harm. We need o change that. In partnership with clinicians, health systems and patients, we can surface this long overdue conversation, and take action to implement a framework to measure and reduce cognitive harm." CW

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The Cognitive Harm Reduction in Medical Care Initiative

Deloitte research shows that direct medical costs from health inequities in health care systems could exceed $1 trillion by 2040 if left unaddressed.

Behind those numbers are patients who weren’t believed, women whose pain was labeled “anxiety,” while conditions worsened because no one paused to listen. Each time a patient leaves uncertain or unheard, the risks of missed diagnoses, repeat visits, and delayed treatment expenses rise.

For health systems and insurers, cognitive harm is a structural liability. Sustainable reimbursement models supportive of reducing cognitive harm are essential.

The initiative will address many aspects of care including: clinical communications, systemic design flaws, reimbursement models, power dynamics and patient engagement.

By redefining those practices collaboratively, we can make medical care safer, more effective, and more accountable. 

Join us as we build a future where cognitive safety is recognized as essential to quality health outcomes.

Donate to phase 2 of the initiative

Four pillars of the Cognitive Harm Reduction Initiative

Our initiative is built on four foundational pillars that make cognitive safety measurable, actionable, and central to quality care. Each pillar advances safer, more human-centered healthcare—grounded in collaboration.

Measurable outcomes

We co-define and track cognitive harm metrics, making invisible risks visible and actionable for care teams.

Patient resources

Guided engagement tools help patients navigate care, supporting psychological safety, and confident choices.

Provider frameworks

Clinician tools reduce overload, foster trust, and support patient understanding—improving outcomes for everyone.

System-level change

We partner with health insurance systems to embed cognitive safety into training, certification, and care delivery at every level.

Now is the time to get involved

Our initiative is a collaboration of several partnerships, organizations who are committed to urgently studying and implementing cognitive harm solutions.

Clinicians
Health insurers
Research universities
Hospital systems
Policy institutes
Philanthropic partners

Collaborate with the foundation

Join applied research to advance cognitive safety.

Work with leaders shaping measurable standards.

Help set new norms for safer care.

Get involved
Image of clinical team meeting to reduce cognitive harm through The Limitless Foundation Cognitive Harm Reduction Initiative
Learn more about the cognitive harm reduction initiative

Connect with us to learn how your organization can get involved.

We're inviting universities, research institutions, clinicians, patients, insurance and healthcare systems to collaborate through applied research, pilot programs, and clinical participation.
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Cognitive safety: your questions answered

Explore key concepts, research insights, and ways to advance cognitive safety in healthcare.

What does cognitive harm mean?
How does it impact patient outcomes?
Who faces the highest risk?
How can insurance and health systems address cognitive harm?