Theft was widely endorsed at a session today examining the challenges and opportunities of patient safety in rural hospitals. The focus was the Maine Critical Access Hospital Patient Safety Collaborative, in which 14 of the state’s CAHs have come together to work on common issues around safety and quality improvement. Each hospital received a $50,000 state grant to implement medication safety projects, including purchasing and installing smart pumps, bar coding and other technologies. They work within the collaborative to exchange ideas and share lessons learned along the way.
The major obstacle for such far-flung hospitals was evident from the get-go. “To start a collaborative, you need to build relationships,” said Judy Tupper of the University of Southern Maine’s Muskie School of Public Policy. “That’s really hard to do when you have to drive five hours to a meeting.” Though most of the interaction among participants takes place via conference call, the grant criteria require face-to-face meetings every quarter. In a small hospital, when a staff member leaves for any length of time, there’s nobody to replace them, Tupper pointed out.
On the other hand, building an interdisciplinary team to tackle a problem like medication safety is much easier with a small staff. One attendee pointed out that most people working at rural hospitals wear so many different hats the staff is interdisciplinary by nature. And they bring that varied experience to bear within the collaborative.
Another advantage: “There seems to be a rapidness to the change cycle that happens in small hospitals,” a participant said. Because staffs are so small, a large percentage of them have already taken part in planning for IT implementation, for instance. When it comes time to roll the project out, most folks already have signed off on it.
Nevertheless, there are bound to staff members who don’t follow the new process for one reason or another. That can make for an uncomfortable situation. “People in a small community know each other,” Tupper said. “People working in the hospital are your friends and neighbors. It can be tough when the time comes to hold people accountable, because you know them so well.” Be firm, Tupper urged: Demonstrate your personal commitment to patient safety and quality improvement and make it clear everyone is expected to have the same commitment.
Collaborative participants at today’s session were enthusiastic about the project and said it allows them to learn from each as they go along. “Even in failure, you learn from one another,” one participant said. “It’s powerful to share this much information.”
Or, as another participant put it: “The thing I like best is we’re able to steal the great ideas everybody else has.”
Bill Santamour, managing editor of H&HN, is blogging from the IHI conference.
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