Culture Eats Strategy for Breakfast

by Webmaster
Published on Jun 22, 2016

A study published in the Annals of Internal Medicine concludes that without accompanying changes in organizational culture, evidence-based protocols and processes may not be sufficient to achieve high hospital performance in care of patients with acute myocardial infarction.


Generally attibuted to management guru Peter Drucker, the old adage about organizational culture trumping any business strategy has been repeatedly demonstrated.  Just think about  customer service at Nordstrom or the loyalty of the employees of Southwest Airlines. When hospital business strategies, policies and rules collide with the culture of the organization, culture always wins.

A few years ago, there was an article in the Annals of Internal Medicine that demonstrated that hospital culture also has an impact on clinical outcomes. Researchers, supported by a grant from the Agency for Healthcare Research and Quality wanted to know what distinguishes hospitals with low AMI mortality rates from those with the highest rates.  They found that hospital culture and organizational cohesion made the difference.

The researchers spoke with staff at 11 different hospitals; some were in the top 5% in terms of low AMI mortality while some were in the bottom 5%. They reported finding a two-fold difference in mortality rates beteen those two groups even though both types of hospitals had similar procedures and protocols and both had hospitalists caring for the patients.  However, researchers found that hospitals with the lowest AMI mortality shared key organizational characteristics that distinguished them from those with high mortality rates.  Features that were prominent among the hospitals with low rates were wide-spread organizational values of excellence and innovative approaches to problem solving. The interviewees in the low mortality rate hospitals reported greater engagement of senior management in cardiac care backed by both financial and nonfinancial resources;  they reported working well as teams with care coordination between team members being highly effective; good communication and coordination across departments that led to creative problem solving; and a strong culture of holding regular committee meetings involving all involved clinicians. 

Study concludes that without accompanying changes in organizational culture, multidisciplinary meetings, evidence-based protocols and processes may not be sufficient to achieve high hospital performance in care of patients with acute myocardial infarction.