Improving the organizational culture of hospitals may decrease heart attack mortality rates, Yale researchers have found.

Researchers in the School of Public Health conducted a two-year intervention at 10 hospitals around the country with the hopes of improving hospital culture and decreasing the number of deaths due to heart attacks. The team published a paper detailing their efforts in the journal BMJ Quality & Safety on Nov. 3.

“We’re hoping that the study raises awareness of the importance of paying attention to the environment of spaces in which we work,” said Leslie Curry, senior research scientist and first author of the paper. “In a hospital, we really need diverse perspectives to have a holistic view of the patient and the way patients are cared for.”

By the project’s end, hospitals that had successfully implemented the researchers’ intervention experienced a positive change in their work environment and a decline in the rate of heart attack mortality.

According to co-author Erika Linnander, the intervention had two key goals: to build a coalition of those involved in treating heart attacks within a hospital and to increase the flow of knowledge and experience between hospitals.

Due to improvements in modern medicine and technology, hospitals nationwide have seen a decline in the mortality rate of heart attacks; however, that rate has slowed in recent years, Curry said. Unlike the national average, though, hospitals that successfully implemented the intervention continued to see a relatively fast decline, she added.

The decline in mortality rates experienced by the hospitals in the study supports the team’s thesis that improving hospital culture can save lives, President of Vassar College, former public health professor at Yale and co-author of the paper Elizabeth Bradley said.

“Having people appreciate that they can create cultures that support better performance is really important in terms of impact,” Curry said. “And of course, the ultimate impact is having people save lives.”

For their intervention, the research team instructed 10 hospitals to create an interdisciplinary coalition of approximately 15 to 25 people involved in the treatment of heart attacks, including doctors, nurses and administrators. The coalitions then participated in on-site workshops that guided their efforts to change hospital culture and to implement new evidence-based practices. Each coalition also sent representatives to attend annual meetings to discuss their progress.

“For most hospitals, this was the first time they had brought together a coalition that spanned across multiple disciplines, reached outside of the hospital walls and cut across layers of the hierarchy,” Linnander said. “We had folks in these coalitions that were frontline providers, that had never sat at the table with these senior executives.”

Out of the 10 hospitals that undertook the intervention, six were successful, according to the researchers’ metrics, Linnander said. The hospitals that were successful invested in the diverse perspectives of coalition members and were able to manage some of the challenges that arose due to the changes they were making, said Amanda Brewster, research scientist at the School of Public Health and co-author of the study. Changing the culture of an institution — particularly one with a hierarchal structure — can be challenging, Curry said.

The key to a successful coalition was diversity, Curry added. In addition to the general composition of the group, hospitals were encouraged to involve non-hospital staff, such as post-hospital caregivers and EMTs, in order to form a more comprehensive view of the care a patient receives, she said.

The researchers collected a mixture of quantitative and qualitative data to evaluate the organizational culture at the hospitals, Brewster said. After the intervention, Curry said, many employees reported feeling more comfortable taking risks, speaking their minds and engaging with senior leadership.

The researchers’ intervention model builds on previous research, Bradley said. She explained that the researchers had found that hospitals with lower heart attack mortality rates had more collaborative cultures, prompting their interest in formulating an intervention.

With the financial support of the Donaghue Foundation, the team will consolidate its methodology and make it available to other hospitals through the American College of Cardiology’s Quality Improvement portal, Linnander said. The researchers said they plan to continue advocating for the role new leadership strategies play in institutional culture and patient outcomes.

Around 735,000 Americans have a heart attack annually, according to the Centers for Disease Control and Prevention.

Maya Chandra |