Hospitals: Patient and Staff Members

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Safety Issues: Similarities, Differences Exist Among Small and Large Hospital Comment Email Print RSS News Widget ShareThis
Heather Comak, April 20, 2009
Although the general principles of what goes into creating a culture of safety are the same at small and large hospitals, both types of facilities face different hurdles when addressing the topic.

"I think that there is not a substantive distinction," says Jennifer Lundblad, PhD, MBA, CEO of Stratis Health in Bloomington, MN, about the culture of safety in the two settings. "You can focus all you want on clinical change, but if you are not also simultaneously focusing on issues of the culture in a hospital, those changes are probably not sustainable, because culture drives so much of what occurs in terms of adverse events."

The Agency for Healthcare Research and Quality (AHRQ) recently published its annual Hospital Survey on Patient Safety Culture: 2009 Comparative Database Report. The report compiles data from hospitals utilizing its Hospital Survey on Patient Safety Culture, originally released in 2004. Stratis Health, a nonprofit organization that works with hospitals on national and local levels to improve quality, helped implement this survey tool in Minnesota's hospitals as that state's Medicare Quality Improvement Organization. Karla Weng, MPH, CPHQ, program manager at Stratis Health, says that generally, small rural hospital score higher on the AHRQ survey.

"In particular, the biggest gap was on handoffs and transitions, they were 22% higher than their urban counterparts," says Weng.

Communication and Openness
Handoffs, in particular, highlight one of the areas in which small and large facilities have unique sets of problems. Coordination and communication between different departments are often the lowest scored domains when measuring the culture of safety.

"I think those are especially problematic in large organizations, just because of the complexity in dealing with...
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