Patient safety organizations (PSO) encourage transparency and sharing of data to prevent failure. This report analyzed interviews from 600 acute-care hospitals on the PSO program. While participants found value in the program, challenges to PSO participation include redundancy with other patient safety work, mistrust of PSO legal protections, and lack of adoption of the AHRQ Common Formats. Improving communication efforts to enhance awareness of PSOs is a primary recommendation from report authors to engage more hospitals in the program.