Hospital patient safety - strategy

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Keeping patient safety at the forefront

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.


After the Institute of Medicine released its report "To Err is Human: Building a Safer Health System" in 1999, patient safety grew as a national concern.The landmark publication estimated that as many as 98,000 people die in U.S. hospitals each year as a result of medical error that could have been prevented. It outlined a strategy for reducing medical mistakes and set a five-year goal. Quality inititatives had existed for years, but the Institue of Medicine report triggered major shifts in the health care landscape. Quality and safety moved to the forefront of pressing industry issues.


The Duke Endowment began a special focus on patient safety in 2000. Through discussions with health care leaders, educational conferences and grants, the Endowment hoped to encourage hospitals to create opportunities for open dialogue and develop an environment where people can learn from mistakes. The Endowment also hoped to encourage hospitals to find best practice models for monitoring systems and error reduction strategies.

Milestones included:

  • 2001: Four organizations - Duke Medical Center in Durham, N.C., Northeast Medical Center in Concord, N.C., Iredell Memorial Hospital in Statesville, N.C., Wayne Memorial Hospital in Goldsboro, N.C. - received grants to purchase and implement new technologies aimed at reducing medical errors. The technologies included bar coding systems, physician order entry systems and electronic medical records.
  • 2003: A collaborative of seven hospitals and health systems in South Carolina received an Endowment grant to improve patient and worker safety through a multi-year effort.
  • 2003 and 2004: The Endowment sponsored representatives from the Carolinas to complete a yearlong intensive learning experience with the American Hospital Association's Health Forum Patient Safety Leadership Fellowship Program.
  • 2003: Leaders in South Carolina approached the Endowment to discuss their vision for a partnership between health systems and universities. In 2004, Health Sciences South Carolina was founded.
  • 2004: The North Carolina Hospital Association established a Center for Hospital Quality and Patient Safety using a $5 million, multi-year Endowment grant.
  • 2004: The South Carolina Hospital Association convened a committee on patient safety to review issues and help with statewide activities.
  • 2006: The Endowment initiated a special grant program focused on health information technology.
  • 2006: The South Carolina Hospital Association formalized patient safety efforts using a $3 million, multi-year grant from the Endowment. With Endowment funds, the association hired a medical director to create the framework for shifting South Carolina's hospital culture from competition to collaboration.
  • 2006: A $21 million, multi-year Endowment grant to Health Sciences South Carolina helped establish infrastructure to advance education and research. Health Sciences South Carolina is the only statewide collaborative of its kind in the United States to pool the resources of research universities and health systems.

Participating sites

North Carolina Hospital Association
South Carolina Hospital Association
Health Sciences South Carolina


Quality center helps N.C. hospitals focus on patient safety

A nurse since 1985, Joan Wynn remembers when the Institute of Medicine released its 1999 publication, "To Err is Human: Building a Safer Health System."

Across the United States each year, the report said, as manay as 98,000 people were dying in hospitals as a result of medical errors. Preventable mistakes - such as improper transfusions or wrong-site surgery - caused more deaths than motor-vehicle wrecks, breast cancer and AIDS.

"There were lots of questions when the report was published," Wynn says. "Is this for real? Is it fear-mongering? Is it accurate? How do we respond? It was a tipping point."

Wynn is now the chief quality and patient safety officer for University Health Systems of Eastern Carolina, a regional health system that serves 29 North Carolina counties. From her office in Greenville, N.C., she works closely with the North Carolina Center for Hospital Quality and Patient Safety, established in 2005 to support hospitals with quality and patient safety activities.

A five-year grant from The Duke Endowment funds the Quality Center, along with a donation from Blue Cross Blue Shield of North Carolina. Dr. Carol Koeble, an OB/GYN physician, is the director.

Created by the North Carolina Hospital Association, the Quality Center offers educational and collaborative programs and performance measurement services. Although still in its infancy, it has already engaged and supported nearly every hospital in the state.

One collaborative, for example, is focused on improving surgical care. Called the North Carolina Surgical Care Improvement Project, the effort began in 2007 and has brought together 60 hospitals.

Another collaborative program is helping hospitals establish a culture that supports shared accountability and moves away from a punitive atmosphere.

The Quality Center also developed the N.C. Hospital Quality Performance Report (, which provides standardized quality information to consumers.

"Are patients safer now than they were in 1999? I think so," Wynn says. "They are armed with better information about hospitals because of public data. They know what questions to ask and they can advocate for themselves. Quality and safety have moved to the forefront of what we do in health care and that makes for a better system for patients."

[caption for Joan Wynn headshot] Joan Wynn is the chief quality and patient safety officer for University Health Systems of Eastern Carolina, a regional health system that serves 29 North Carolina counties.

Contact us
Mary L. Piepenbring, Director of Health Care