Changing hospital organisational culture for improved patient outcomes: developing and implementing the leadership saves lives intervention

Abstract

BackgroundLeadership 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 developmentHospitals 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.ResultsWe 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.ConclusionsThis 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.

Principles for Real-World Implementation of Bedside Predictive Analytics Monitoring

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Developing a theory-based behavior change intervention to improve the prescription of surgical prophylaxis

“…The data also showed that in the Egyptian context, a top bottom approach is appropriate to drive a change; meaning that engaging senior physicians and department directors is essential for any change in the practices of younger physicians. Trust in the perceptions of senior practitioners have been shown to be powerful reasons for the inappropriate prescription of antibiotics in several countries in the world [ 46 , 47 ].…”

Solving the Puzzle of Global Health Inequity: Completing the Picture Piece by Piece by Piece

“…System redesign to assist in the eradication of global health inequities clearly requires the successful recruitment and retention of appropriate healthcare workers, which is an international problem in rural, remote, and very remote contexts (Hines et al, 2020b ). It is possible, however, to use system-wide interventions to change important elements such as organizational culture and leadership (Linnander et al, 2020 ). For changes to be effective, responsive, and sustained, decisions regarding system reform should be informed by the genuine and meaningful contributions of all stakeholders including patients (Rabideau, 2020 ) and Community Health Workers (Schurer et al, 2020a , 2020b ).…”

“…Process: Engaging What is the ideal organization of health services and systems for eradicating global health inequities? •Systems must provide specialist but essential services during global pandemics •Ongoing monitoring and evaluation could guide the redesign of services and systems •Recruitment and retention of appropriately trained and skilled staff is critical Ademuyiwa et al ( 2020 ), Lazarus et al ( 2020a , ( 2020b ), Binagwaho and Mathewos ( 2020a ), Phillips et al ( 2020 ), Binagwaho et al ( 2020a , 2020b ), Binagwaho and Mathewos ( 2020b ), Carey and Binagwaho ( 2020a ), Binagwaho ( 2020 ), Henley ( 2020 ), Schurer et al ( 2020 ), Semrau et al ( 2020 ), Hines et al ( 2020b ), Linnander et al ( 2020 ), Rabideau ( 2020 ), Schurer et al ( 2020a , 2020b ) III. Inner setting: Readiness for implementation—available resources IV.…”