It is really tricky in organisations of different sizes and with different geography.
Small organisations have fewer people to draw on and often fewer incidents so identifying trends or forming a working group with a new perspective can be a challenge but you can have great conversations because everyone is based together.
Community Trusts have different challenges. They are likely to have more disparate teams on stand alone sites across large geography making coming together difficult. They may work in different systems i.e. Community Hospitals may be linked to different acutes for microbiology so different reporting systems and different antibiotic prescribing protocols. The meeting structure can be very hierarchical as a way of managing workloads but this can make the decision making remote form the frontline. They do however, by their nature, have a more diverse workforce which opens up more lateral problem solving if harnessed correctly.
I am not convinced it is more or less difficult in any area, the challenges (but also the options to be creative) are just different.
I think there is something about honest conversations and reducing organisational fear about looking outward. Make it okay for me to talk to a Community Trust in the North about where I am with falls and share solutions. Use technology sensibly to enable conversation (video conferencing not conference calling). Above all the people with the greatest insights into what we could do better are our frontline staff, patients and carers and they are right there where the care is being delivered.
I joined a webinar today about clinician burnout and one of the discussions resonated for patient safety. They talked about "silly rules" and how they govern behaviour. If clinicians in whatever setting could have the courage to say this rule is negatively impacting on patient safety (e.g. say pedal bins with lids are required in toilets but patients are falling over trying to balance to open them) then there can be a open debate about the greater risk.
Not sure any of this helps @Claire Cox but happy to discuss further.