Thursday, 17 March 2011

Culture and cardiac care quality

"High-performing hospitals were characterized by an organizational culture that supported efforts to improve AMI care across the hospital. Evidence-based protocols and processes, although important, may not be sufficient for achieving high hospital performance in care for patients with AMI."

concluded researchers in the US who looked at hospitals ranked in the top or bottom 5% in mortality rates for acute MI. (1)

What differentiated the best performing hospitals from the weakest was not their use of guidelines or dedicated teams but organisational values, communication, coordination and problem solving capabilities.

From a performance improvement perspective quantitative outcomes of mortality rates and compliance with scientific evidence are only the starting point for designing an educational intervention. The real challenge is correctly analysing and addressing the more woolly qualitative issues that can be the more resistant barriers to performance improvement.

The medical education world is evidence-based obsessed and rightly so. However, it also needs to recognise that the higher educational outcomes of analysis, synthesis and creativity need to be addressed as well as the broadcasting of knowledge.

An old (medic) joke about medical schools' teaching ward rounds is that they often resemble shifting dullness.(2) If the round only involves talk of knowledge and existing evidence and does not explore the organisational and cultural perspectives of patient care then it certainly will be dull (and less effective).

So, this report in the Annals of Internal Medicine makes for interesting reading and opens the field for similar league table research in other therapeutic areas.

1. Curry LA, Spatz E, Cherlin E, et al. What Distinguishes Top-Performing Hospitals in Acute Myocardial Infarction Mortality Rates? Annals of Internal Medicine. 2011;154(6):384 -390. Available at: [Accessed March 17, 2011].

2. "Shifting dullness" being a clinical sign of ascites not the implied meaning of "mobile stupidity".

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