When a hospital is faced with limited resources and staff, it can be hard enough to fight the day's battles, let alone setting sights on broader patient safety efforts. Yet, a handful of smaller hospitals are tackling harm with the same vigor and skill as the biggest and best, simply by engaging others and sharing best practices.

For the past two years, some 1,500 hospitals and 31 state hospital associations across the country have banded together to try to improve quality and patient safety. The common thread is the American Hospital Association's Health Research & Educational Trust which, with the help of a $75 million grant, has formed a Hospital Engagement Network to help organizations learn from one another. All told, there are 26 different HENs doing the same thing, funded by a total of $218 million in HEN grants from Health & Human Services.

At 25-bed, critical access hospital Pulaski Memorial Hospital in Winamac, Ind., constant improvement isn't an option — it's a requirement. Located within driving distance to major hospitals in cities like Chicago and South Bend, Ind., patients have access to much larger facilities. But with the help of the HRET Hospital Engagement Network, Pulaski has gained access to the same knowledge and resources as big guys, says President and CEO Tom Barry.

"Quality is so important and we're driving that throughout the organization," he told me by phone last week. "At times, people say, ‘Well, can we really afford to do this?' And the real answer is we can't afford not to. If we don't have that quality, our patients won't keep coming here."

By accessing a wealth of HEN resources — digging into data, sharing best practices, or tapping into workshops and webinars — at little to no cost, Pulaski has made tremendous improvements to the care it delivers. Those include adopting a hard-stop policy to reduce early elective deliveries, cutting surgical-site infections by 75 percent, and reducing medication errors with the drug warfarin to zero last year (see video below).

Similarly, Allison Rachal, quality director for 51-bed Avoyelles Hospital, in Marksville, La., says it doesn't take deep pockets to excel at quality and patient safety. Watch seminars over the Web, take time to meet with colleagues to discuss ways to improve and investigate your mistakes thoroughly, Rachal says. With the help of the HRET HEN, Avoyelles has made strides in patient safety and quality, decreasing pressure ulcers by 40 percent, and dropping the number of medication errors and patient falls (see video below). "I think just sharing our knowledge, our experiences and our day-to-day tasks helps us to function the best that we can," she says.


While it may not be possible to eliminate all avoidable mistakes in small hospitals, because of the human factors that come into play, every leader should strive for zero, says Nancy Newby, CEO of Washington County Hospital, another HEN participant located in southern Illinois.

"Certainly you're striving to get closer to zero," she says. "I don't know if — in a real world, with human nurses and human doctors and real, sometimes uncooperative, patients — that the hospital will ever be a perfect environment. But I think our goal always has to be to make it better, and to make it as safe as we possibly can. No doctor or nurse ever wants to harm a patient."