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Background: Disseminating new safe practices has proved challenging. In a statewide initiative we developed a framework for (1) selecting two safe practices, (2) developing operational details of implementation, (3) enlisting hospitals to participate, and (4) facilitating implementation., Methods: Potential topics were selected by a multistep process to identify candidate practices, review the evidence for efficacy and feasibility, and then select them on the basis of importance, efficacy, feasibility, and impact. A multi-stakeholder advisory group representing all constituencies selected two practices: reconciling medications (RM) and communicating critical test results (CTR). Operational details and strategies for implementation were then developed for each practice using a consensus process of discipline stakeholders led by content experts. Hospital CEOs were solicited to participate by the Massachusetts Hospital Association which made the project a "flagship" initiative. A collaborative model was used to facilitate implementation, following the IHI Model for Improvement. In addition to providing exposure to content and method experts, we gave teams a "toolkit" containing recommendations, a change package, and implementation strategies. Each collaborative met four times over an 18 month period. Results were assessed using the IHI team assessment scale and surveys of teams and hospital leaders., Results: Hospital participation rate was high with 88% of hospitals participating in one or both collaboratives. Partial implementation of the practices was achieved by 50% of RM teams and 65% of CTR teams. Full implementation was achieved by 20% of teams for each., Conclusions: Major factors leading to hospital participation included the intrinsic appeal of the practices, access to experts, and the availability of implementation strategies. Team success was correlated with active engagement of a senior administrator, engagement of physicians, increased use of PDSA cycles, and attendance at collaborative meetings. The prior development of subpractices, recommendations and implementation strategies was essential for the hospital teams. These should be well worked out before hospitals are required to implement any guideline.

Background: Fifty hospitals collaborated in a patient safety initiative developed and implemented by the Massachusetts Coalition for the Prevention of Medical Errors and the Massachusetts Hospital Association., Methods: A consensus group identified safe practices and suggested implementation strategies. Four collaborative learning sessions were offered, and teams monitored their progress and shared successful strategies and lessons learned. Reports from participating teams and an evaluation survey were then used to identify successful techniques for reconciling medications., Results: For the 50 participating hospitals, implementation strategies most strongly correlated with success included active physician and nursing engagement, having an effective improvement team, using small tests of change, having an actively engaged senior administrator, and sending a team to multiple collaborative sessions., Discussion: Adoption of the reconciling safe practices proved challenging. The process of writing medication orders at patient transfer points is complex. The hospitals' experiences demonstrated that implementing the proposed safe practices requires a team effort with leadership support and vigilant measurement.

Background: Massachusetts hospitals have collaborated in a patient safety initiative conducted by the Massachusetts Coalition for the Prevention of Medical Errors and the Massachusetts Hospital Association which is aimed at improving the ability to communicate critical test results in a timely and reliable way to the clinician who can take action. Solutions to this problem would address enhancing communication, teamwork, and information transfer, all fundamental system factors linked to patient safety. DEVELOPING THE SAFE PRACTICE RECOMMENDATIONS AND THE "STARTER SET": A Coalition-convened Consensus Group defined critical test results as values/interpretations for which reporting delays can result in serious adverse outcomes for patients. The scope included laboratory, cardiology, radiology, and other diagnostic tests in inpatient, emergency, and ambulatory settings. The Consensus Group developed Safe Practice Recommendations to promote successful communication of results, and a "starter set" of test results sufficiently abnormal to be widely agreed to be considered "critical.", Dissemination: The recommendations and the starter set of test results were disseminated in a statewide collaborative open to all Massachusetts hospitals. Hospitals' team members tested changes and shared successful strategies that improved the reliability of communicating critical test results. An evaluation of the results of this collaborative is underway.