Raising Standards for Health Care Quality

Joan Wynn, chief quality and patient safety officer for University Health Systems of Eastern Carolina (a regional health system that serves 29 counties) works with the North Carolina Center for Quality and Patient Safety.

The Duke Endowment has awarded nearly $40 million in 11 multi-year grants to help hospitals create a culture of safety in North Carolina and South Carolina and reduce mistakes that might harm patients.

Insights

Four key activities have contributed to the success of patient safety grants. We invite others to use these findings as a starting point for their own efforts.

1. Let your results from a pilot project drive your next investment. The Duke Endowment knew early on that specific technologies had the potential to reduce medical errors. In 2001, the Endowment funded pilot projects for four N.C. hospitals to purchase and implement new technologies.The pilots proved effective—but the Endowment also knew that hospitals needed to go beyond technology to change their culture and promote comprehensive patient safety programs. Information technology became a special grant program of its own.
2. Patient safety programs require collaborative thinking. The Endowment wasn't sure whether competitive hospitals could come together to share knowledge, problems, resources and results. But industry leaders embraced the idea and willingly collaborated. As a result of this healthy peer support, the Endowment began funding statewide efforts through hospital associations in North Carolina and South Carolina.
3. External consultants expedited positive change. Organizations and funders need to consider paying for expert advice at the national level. North Carolina and South Carolina experienced better, quicker results because national consultants provided technical support and guidance.
4. Monitoring outcomes and communicating with providers is critical. If you're trying to improve patient safety, you must measure it. It's crucial to share that data with providers so they can begin to compare themselves to others and to national benchmarks. Hospitals in both North Carolina and South Carolina are now voluntarily reporting their data (see Resources).

Impact

Since the beginning of the patient safety program, The Duke Endowment has awarded $37.5 million in grants. The effort has grown from four grants in North Carolina and South Carolina, to concentrated statewide efforts aimed at improving systems of care that reduce errors. With the efforts of hospitals and hospital associations, the Carolinas are beginning to see a noticeable shift in the culture. Instead of denial and blame, there's now evidence of learning and improvement.

In South Carolina:

• 100 percent of hospitals participate in a hospital-initiated partnership for quality and safety.
• The state's quality campaign has the nation's largest network of supporting partners.
• The first South Carolina Patient Safety Symposium in March 2008 attracted more than 300 participants.
• In 2005, Health Sciences South Carolina and its partner organizations provided funding to establish the Center for Clinical Effectiveness and Patient Safety. The director's job: Establish a statewide network of simulation centers that will help students practice a procedure before treating live patients.

In North Carolina:

• The North Carolina Hospital Association created the North Carolina Center for Hospital Quality and Patient Safety in 2005. By 2008, the center was providing education and training programs, clinical measurement services and collaborative learning programs.
• The Center for Hospital Quality and Patient Safety has created several popular toolkits for hospitals, including one on eliminating Methicillin-resistant Staphylococcus aureus (MRSA) and one on medication reconciliation.
• The Center for Hospital Quality and Patient Safety launched the North Carolina Patient Safety Training Program, developed the voluntary North Carolina System for Hospital Infections Measurement and a hospital-specific performance report.

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