What distinguishes top-performing hospitals.....

In recent years, public reporting of hospitals' performance is becoming increasingly common in America to improve patient outcomes and accountability. Many hospitals have made substantial efforts in quality improvement including investing in high-tech equipments and systems, but disparities still persist between the highest and lowest performing hospitals in patient mortality rates.

According to a new study, conducted by Yale Global Health Leadership Institute at Yale University, published in the Annals of Internal Medicine, between 2005 and 2007, the 30-day mortality rates for Medicare heart attack patients ranged from 11.4%-14% among the high performers and 17.9%- 20% among the low.

Earlier studies suggested that the high mortality rates in low-performing hospitals could have been caused by factors such as hospital location, bed size, for-profit status, nurse staffing ratio and patient population, eg black, elderly. However, the Yale researchers found that these factors accounted for a small percentage of the variation between the high and low peforming hospitals.

They compared the characteristics of 11 hospitals ranking the top or bottom 5% measured by the 30-day mortality rates for acute myocardial infarction (AMI). They interviewed 158 key staff who were involved with AMI care at the hospitals and found few differences in protocols and processes used in treating heart attacks, but what differentiated the high performers from the low was how they did things - a shared organisational culture that focused on communication and support to improve patient care.

They found that high-performing hospitals were characterised by the followings :
- staff shared organisational values and goals of providing high quality care
- senior management involvement and commitment to high quality care

- broad staff presence and expertise in clinical decision making
- strong communication and coordination across disciplines and departments resulting in seamless transitions in care
- used adverse events and feedback as opportunities for problem solving that focused on nonpunitive learning

The study concluded that protocols and processes are not sufficient for achieving high performace in AMI care but "long-term investment and concerted efforts to create an organisational culture that supports full engagement in quality, strong communication and coordination .... problem solving and learning across the organisation" may be required.

Source: What Distinguishes Top-Performing Hospitals in Acute Myocardial Infarction Mortality Rates? A Qualitative Study. Annals of Internal Medicine. March 14, 2011 vol. 154 no. 6 384-390 ( f/t via Athens)