Hospitals with substantial shifts in organisational culture had significantly greater reductions in AMI risk-standardised mortality rates than those without (1.07 vs 0.23 percentage points; p=0.03).
Does fostering improvements in organisational culture improve hospital performance and reduce risk-standardised mortality rates in patients with acute myocardial infarction?
Improving hospital organisational culture is associated with increased use of evidence-based strategies and greater reductions in risk-standardised mortality rates for acute myocardial infarction.
Absolute Event Rate: 1.07% vs 0.23%
p-value: p=0.03
BACKGROUND: Hospital 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. METHODS: This 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. RESULTS: We 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. CONCLUSIONS: Investing in strategies to foster an organisational culture that supports high performance may help hospitals in their efforts to improve clinical outcomes.
Curry et al. (Fri,) conducted a other in acute myocardial infarction (n=10). Strategies to foster improvements in organisational culture vs. Hospitals that made less progress in shifting culture was evaluated on Reduction in risk-standardised mortality rates (RSMR) (p=0.03). Hospitals with substantial shifts in organisational culture had significantly greater reductions in AMI risk-standardised mortality rates than those without (1.07 vs 0.23 percentage points; p=0.03).