If you hire the top people in their professions and have state-of-the-art technology, will that ensure organizational success? A study reported in the March issue of Annals of Internal Medicine provides evidence that hospital culture has more influence on improving patient outcomes than elements such as reputation of physicians, electronic records systems, state-of-the-art equipment, or evidence-based protocols.The investigators looked at mortality rates for patients with AMI (acute myocardial infarction)and then followed up with site visits and in-depth interviews of hospital staff. Apparently, in complex organizations like hospitals, “how” is more important than “what”. In a post on Tara Parker-Pope’s health blog titled “What Makes a Hospital Great,” Pauline W. Chen describes the findings from this Yale University research:
…it was the approach to challenging patient care issues that seemed to set institutions apart. A hospital might discover, for example, that a heart attack patient who returned to the hospital with severe edema, or swelling, might have been discharged without her prescribed diuretic…At a low-performing hospital, such an error might result in doctors, nurses and pharmacists on the front lines blaming one another and hospital leaders taking care to remain uninvolved. But clinicians and leaders at a high-performing hospital would be eager to address the error, acknowledging it without disparaging one another and working together to re-examine and, if necessary, reconfigure the hospital’s discharge process.
Consistent with these findings is Stanford medical professor Abraham Verghese’s contention that the bed-side, doctor-patient relationship is critical to achieving successful patient outcomes. He argues that doctors today are over-reliant on technology to diagnose and treat patients and do not know how to physically examine and “listen to” patients. This results in misdiagnosis, unnecessary lab tests, and a lack of mutual trust that is vital to patient care. Verghese believes that physicians can’t learn bedside skills any other way than by treating patients and receiving feedback from senior physicians who can teach the hands-on skills. However, this kind of learning is dependent on a hospital culture that values and supports the bedside, doctor-patient relationship.
Culture, with all of its values, assumptions, beliefs, expected behaviors, and norms, is a powerful force within organizations. Culture shapes how things are done. In hospitals, culture has life and death implications. Evidence suggests that health care outcomes are improved when the culture of a hospital encourages trust and honesty among staff and with patients and when people act consistently in accordance with these values.
