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Linnander E, McNatt Z, Sipsma H, Tatek D, Abebe Y, Endeshaw A, Bradley EH. Use of a national collaborative to improve hospital quality in a low-income setting. Int Health 2016; 8:148-53. [PMID: 26796023 PMCID: PMC4778631 DOI: 10.1093/inthealth/ihv074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/14/2015] [Indexed: 11/27/2022] Open
Abstract
Background Quality improvement collaboratives are a widely used mechanism to improve hospital performance in high-income settings, but we lack evidence about their effectiveness in low-income settings. Methods We conducted cross-sectional and longitudinal analysis of data from the Ethiopian Hospital Alliance for Quality, a national collaborative sponsored by Ethiopia's Federal Ministry of Health. We identified hospital strategies associated with more positive patient satisfaction using linear regression and assessed changes in patient experience over a 3-year period (2012–2014) using matched t-tests. Results A total of 68 hospitals (response rate 68/120, 56.7%) were included in cross-sectional analysis. Four practices were significantly associated with more positive patient satisfaction (p<0.05): posting a record of cleaning activity in toilets and in patient wards, distributing leaflets in the local language with each prescription, and sharing ideas about patient experience across the hospital. Among hospitals that had complete data for longitudinal analysis (44/68, 65%), we found a 10% improvement in a 10-point measure of patient satisfaction (7.7 vs 8.4, p<0.01) from the start to the end of the study period. Conclusions Quality improvement collaboratives can be useful at scale in low-income settings in sub-Saharan Africa, particularly for hospitals that adopt strategies associated with patient satisfaction.
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Affiliation(s)
- Erika Linnander
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA
| | - Zahirah McNatt
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA
| | - Heather Sipsma
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA
| | - Dawit Tatek
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA
| | | | | | - Elizabeth H Bradley
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, 06520-8034, CT, USA
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Brewster AL, Curry LA, Cherlin EJ, Talbert-Slagle K, Horwitz LI, Bradley EH. Integrating new practices: a qualitative study of how hospital innovations become routine. Implement Sci 2015; 10:168. [PMID: 26638147 PMCID: PMC4670523 DOI: 10.1186/s13012-015-0357-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/30/2015] [Indexed: 11/21/2022] Open
Abstract
Background Hospital quality improvement efforts absorb substantial time and resources, but many innovations fail to integrate into organizational routines, undermining the potential to sustain the new practices. Despite a well-developed literature on the initial implementation of new practices, we have limited knowledge about the mechanisms by which integration occurs. Methods We conducted a qualitative study using a purposive sample of hospitals that participated in the State Action on Avoidable Rehospitalizations (STAAR) initiative, a collaborative to reduce hospital readmissions that encouraged members to adopt new practices. We selected hospitals where risk-standardized readmission rates (RSRR) had improved (n = 7) or deteriorated (n = 3) over the course of the first 2 years of the STAAR initiative (2010–2011 to 2011–2012) and interviewed a range of staff at each site (90 total). We recruited hospitals until reaching theoretical saturation. The constant comparative method was used to conduct coding and identification of key themes. Results When innovations were successfully integrated, participants consistently reported that a small number of key staff held the innovation in place for as long as a year while more permanent integrating mechanisms began to work. Depending on characteristics of the innovation, one of three categories of integrating mechanisms eventually took over the role of holding new practices in place. Innovations that proved intrinsically rewarding to the staff, by making their jobs easier or more gratifying, became integrated through shifts in attitudes and norms over time. Innovations for which the staff did not perceive benefits to themselves were integrated through revised performance standards if the innovation involved complex tasks and through automation if the innovation involved simple tasks. Conclusions Hospitals have an opportunity to promote the integration of new practices by planning for the extended effort required to hold a new practice in place while integration mechanisms take hold. By understanding how integrating mechanisms correspond to innovation characteristics, hospitals may be able to foster integrating mechanisms most likely to work for particular innovations.
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Affiliation(s)
- Amanda L Brewster
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
| | - Leslie A Curry
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
| | - Emily J Cherlin
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
| | - Kristina Talbert-Slagle
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
| | - Leora I Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, New York University School of Medicine, New York, NY, USA. .,Center for Healthcare Innovation and Delivery Science, New York University Langone Medical Center, New York, NY, USA. .,Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY, USA.
| | - Elizabeth H Bradley
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
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Curry LA, Linnander EL, Brewster AL, Ting H, Krumholz HM, Bradley EH. Organizational culture change in U.S. hospitals: a mixed methods longitudinal intervention study. Implement Sci 2015; 10:29. [PMID: 25889753 PMCID: PMC4356105 DOI: 10.1186/s13012-015-0218-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving 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). METHODS This 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. CONCLUSIONS LSL 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.
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Affiliation(s)
- Leslie A Curry
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA. .,Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Erika L Linnander
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
| | - Amanda L Brewster
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
| | - Henry Ting
- New York Presbyterian Hospital, New York, NY, USA.
| | - Harlan M Krumholz
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA. .,Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA. .,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA. .,Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Elizabeth H Bradley
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA. .,Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
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