Organizational culture change in U.S. hospitals: a mixed methods longitudinal intervention study

Abstract

BackgroundImproving outcomes for patients with acute myocardial infarction (AMI) is a priority for hospital leadership, clinicians, and policymakers. Evidence suggests links between hospital organizational culture and hospital performance; however, few studies have attempted to shift organizational culture in order to improve performance, fewer have focused on patient outcomes, and none have addressed mortality for patients with AMI. We sought to address this gap through a novel longitudinal intervention study, Leadership Saves Lives (LSL).MethodsThis manuscript describes the methodology of LSL, a 2-year intervention study using a concurrent mixed methods design, guided by open systems theory and the Assess, Innovate, Develop, Engage, Devolve (AIDED) model of diffusion, implemented in 10 U.S. hospitals and their peer hospital networks. The intervention has three primary components: 1) annual convenings of the ten intervention hospitals; 2) semiannual workshops with guiding coalitions at each hospital; and 3) continuous remote support across all intervention hospitals through a web-based platform. Primary outcomes include 1) shifts in key dimensions of hospital organizational culture associated with lower mortality rates for patients with AMI; 2) use of targeted evidence-based practices associated with lower mortality rates for patients with AMI; and 3) in-hospital AMI mortality. Quantitative data include annual surveys of guiding coalition members in the intervention hospitals and peer network hospitals. Qualitative data include in-person, in-depth interviews with all guiding coalition members and selective observations of key interactions in care for patients with AMI, collected at three time points. Data integration will identify patterns and major themes in change processes across all intervention hospitals over time.ConclusionsLSL is novel in its use of a longitudinal mixed methods approach in a diverse sample of hospitals, its focus on objective outcome measures of mortality, and its examination of changes not only in the intervention hospitals but also in their peer hospital networks over time. This paper adds to the methodological literature for the study of complex interventions to promote hospital organizational culture change.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0218-0) contains supplementary material, which is available to authorized users.

Implementation Science and Employer Disability Practices: Embedding Implementation Factors in Research Designs

“…Unfortunately, while these may have explanatory utility, to date, outcomes of attempts to change organisational culture in health care, have been disappointing [87], and it has been argued that a focus on changing organizational climate may be more fruitful [81]. …”

Development and Psychometric Properties of a Scale to Measure Hospital Organizational Culture for Cardiovascular Care

“…Third, we were unable to examine the use of the scale over time. We documented substantial variability based on hospital across the sample of 10 organizations, but future work is warranted to assess whether the scale may be useful in evaluating change over time in hospitals undergoing performance improvement initiatives, such as the LSL study 32 and various collaborative efforts. Last, although our results are promising, additional psychometric testing would be helpful to continue to refine this scale for use in studies of hospital culture change.…”

“…As part of the larger Leadership Save Lives interventional study, 32 we conducted a cross-sectional validation study to test the validity and reliability of the scale to measure organizational culture, a primary outcome of the LSL study, which was still in progress. Thus, our sample comprised the 10 hospitals participating in the LSL study began in 2014.…”

“…Fundamentally, we wanted to develop a scale of closed-ended items that was relatively easy to administer and valid in terms of its measurement of relevant content and constructs of organizational culture. We tested the scale as part of the LSL interventional study (Leadership Saves Lives) 32 with 147 individuals engaged in quality improvement efforts across 10 hospitals nationally from 2014 to 2016. Findings from this study can be used to support more rigorous measurement of organizational culture 2…”

Efficiency Losses in Healthcare Organizations Caused by Lack of Interpersonal Relationships

“…Most of these variabilities/uncertainties have internal causes (Böhme, Williams, Childerhouse, Deakins, & Towill, 2014), causing the need for task-forces to reduce them. But they must count on the top management support (Curry et al, 2015;Parnaby & Towill, 2008).…”