Influencing organisational culture to improve hospital performance in care of patients with acute myocardial infarction: a mixed-methods intervention study

BackgroundHospital organisational culture affects patient outcomes including mortality rates for patients with acute myocardial infarction; however, little is known about whether and how culture can be positively influenced.MethodsThis is a 2-year, mixed-methods interventional study in 10 US hospitals to foster improvements in five domains of organisational culture: (1) learning environment, (2) senior management support, (3) psychological safety, (4) commitment to the organisation and (5) time for improvement. Outcomes were change in culture, uptake of five strategies associated with lower risk-standardised mortality rates (RSMR) and RSMR. Measures included a validated survey at baseline and at 12 and 24 months (n=223; average response rate 88%); in-depth interviews (n=393 interviews with 197 staff); and RSMR data from the Centers for Medicare and Medicaid Services.ResultsWe observed significant changes (p<0.05) in culture between baseline and 24 months in the full sample, particularly in learning environment (p<0.001) and senior management support (p<0.001). Qualitative data indicated substantial shifts in these domains as well as psychological safety. Six of the 10 hospitals achieved substantial improvements in culture, and four made less progress. The use of evidence-based strategies also increased significantly (per hospital average of 2.4 strategies at baseline to 3.9 strategies at 24 months; p<0.05). The six hospitals that demonstrated substantial shifts in culture also experienced significantly greater reductions in RSMR than the four hospitals that did not shift culture (reduced RSMR by 1.07 percentage points vs 0.23 percentage points; p=0.03) between 2011–2014 and 2012–2015.ConclusionsInvesting in strategies to foster an organisational culture that supports high performance may help hospitals in their efforts to improve clinical outcomes.

Download Full-text

Abstract 120: Organizational Culture Change to Reduce 30-day Mortality in Patients With Acute Myocardial Infarction: A Mixed Methods Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.120 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Leslie A Curry ◽

Erika Linnander ◽

Amanda Brewster ◽

Henry Ting ◽

Harlan M Krumholz ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Organizational Culture ◽

Mixed Methods ◽

Data Collection ◽

Patient Outcomes ◽

Intervention Study ◽

Mortality Rates ◽

Peer Networks ◽

Organizational Culture Change

Background: Improving outcomes for patients with acute myocardial infarction (AMI) is a priority for hospitals, clinicians, and policymakers. Evidence suggests hospital organizational culture is linked to patient outcomes; however, few studies have attempted to change organizational culture in order to improve patient outcomes, and none have addressed mortality for patients with AMI. We seek to address these gaps through a novel longitudinal intervention study, Leadership Saves Lives (LSL). We hypothesize that we will observe: 1) positive shifts in key dimensions of hospital organizational culture associated with lower mortality rates for patients with AMI; 2) increased use of targeted evidence-based practices associated with lower mortality rates for patients with AMI; and 3) reduced in-hospital AMI mortality. Methodology and Results: We describe the methodology of LSL, a 3-year intervention study using a concurrent mixed methods design, guided by open systems theory and the AIDED model of diffusion, implemented in a national sample of 10 diverse U.S. hospitals and hospitals in their peer networks. Intervention hospital teams participate in: 1) annual convenings of the 10 hospitals; 2) semiannual workshops at each intervention hospital; and 3) a web-based learning community that includes a discussion board and a repository for resources and tools. We describe features of program design that allow us to promote and measure intervention fidelity, while also allowing for tailoring of the intervention to the unique local context in each hospital. We quantify changes in hospital practices, culture, and mortality through annual surveys of both intervention hospitals in their peer networks. In-person, in-depth interviews and selective observations of key interactions in care for patients with AMI allow us to describe the change process. The intervention began with an annual meting of the 10 intervention hospitals in June 2014. The first wave of survey data collection, hospital-specific workshops and qualitative data collection were completed between September and November 2014. Conclusions: LSL is novel in its use of a prospective longitudinal mixed methods approach in a diverse sample of hospitals, its focus on objective outcome measures of mortality, its attention to maintaining fidelity of the intervention across diverse hospital settings, and its examination of changes not only in the intervention hospitals but also in their peer hospital networks over time. This study adds to the methodological literature for the study of complex interventions to promote hospital organizational culture change, with direct impact on patients with AMI.

Download Full-text