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Changing hospital organisational culture for improved patient outcomes: developing and implementing the leadership saves lives intervention
  1. Erika Linnander1,
  2. Zahirah McNatt2,
  3. Kasey Boehmer3,
  4. Emily Cherlin1,
  5. Elizabeth Bradley4,
  6. Leslie Curry1
  1. 1Global Health Leadership Initiative, Yale University School of Public Health, New Haven, Connecticut, USA
  2. 2University of Global Health Equity, Kigali, Rwanda
  3. 3Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Vassar College, Poughkeepsie, New York, USA
  1. Correspondence to Erika Linnander, Global Health Leadership Initiative, Yale University School of Public Health, New Haven, CT 06520, USA; erika.linnander{at}


Background Leadership Saves Lives (LSL) was a prospective, mixed methods intervention to promote positive change in organisational culture across 10 diverse hospitals in the USA and reduce mortality for patients with acute myocardial infarction (AMI). Despite the potential impact of complex interventions such as LSL, descriptions in the peer-reviewed literature often lack the detail required to allow adoption and adaptation of interventions or synthesis of evidence across studies. Accordingly, here we present the underlying design principles, overall approach to intervention design and core content of the intervention.

Methods of intervention development Hospitals were selected for participation from the membership of the Mayo Clinic Care Network using random sampling with a purposeful component. The intervention was designed based on the Assess, Innovate, Develop, Engage, Devolve model for diffusion of innovation, with attention to pressure testing of the intervention with user groups, creation of a think tank to develop a comprehensive assessment of the landscape, and early and continued engagement with strategically identified stakeholders in multiple arenas.

Results We provide in-depth descriptions of the design and delivery of the three intervention components (three annual meetings of all hospitals, four rounds of in-hospital workshops and an online community), designed to equip a guiding coalition within each site to identify and address root causes of AMI mortality and improve organisational culture.

Conclusions This detailed practical description of the intervention may be useful for healthcare practitioners seeking to promote organisational culture change in their own contexts, researchers seeking to compare the results of the intervention with other leadership development and organisational culture change efforts, and healthcare professionals committed to understanding complex interventions across healthcare settings.

  • healthcare quality improvement
  • health professions education
  • implementation science
  • leadership
  • teamwork

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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Twitter @erika.linnander, @lesliecyale

  • Contributors EL and ZMN conceived and led the intervention. EL and LC conceived and drafted the manuscript. KB participated in the delivery of the intervention. All authors made substantive contributions to the manuscript and reviewed and approved the final submission.

  • Funding This study was funded by The Medicines Company.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All research procedures were approved by the Human Investigation Committee at Yale University and determined to be exempt under Federal Regulation 45 CFR 46.101(b)(2).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing is not applicable as no data sets were generated and/or analysed for this study.

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