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Abstract
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.
- leadership
- quality improvement
- qualitative research
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Contributors LAC, EL and EHB conceptualised, designed and obtained funding for the study. LAC is the Principal Investigator. EHB, AB, EL and LAC drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version.
Funding Funding was provided through a research grant from The Medicines Company, Parsippany, NJ.
Competing interests None declared.
Ethics approval All research procedures were approved by the Human Investigation Committee at the (intentionally omitted for blind review) Human Research Protection Program Committee at (intentionally omitted for blind review) School of Medicine.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Requests for additional unpublished data from interested researchers will be carefully considered on an individual basis upon written request to the corresponding author. However, study participants consented to participate in the study under a guarantee of confidentiality. Because of the small sample of hospitals drawn from a defined network and the specificity of clinical roles and experiences within hospitals, adequate de-identification of unpublished qualitative and quantitative data is likely not possible.