Killer Culture???

Could the organizational culture of a hospital impact patient health? Put more bluntly, can a poor culture kill patients? According to recent research, reported by the Wall Street Journal Health Blog, the answer is yes.

Researchers from Yale studied the top 5% of hospitals whose patients were still alive 30 days after a heart attack, and compared those results to the bottom 5% of hospitals. Their findings, published in the Annals of Internal Medicine conclude:

Hospitals in the high-performing and low-performing groups differed substantially in the domains of organizational values and goals, senior management involvement, broad staff presence and expertise in AMI (acute myocardial infarction) care, communication and coordination among groups, and problem solving and learning.

What does a “healthy” hospital culture look like? The researchers report on a number of factors, including how mistakes are viewed and the regard given all hospital employees. From the Wall Street Journal blog, citing Leslie Curry, one of the Yale researchers:

Using mistakes as learning experiences as opposed to reasons for punishment was another characteristic of top performers, Curry says. And views of nurses, pharmacists, technicians and even housekeeping staff were highly valued in the team approach used at the best hospitals, she added.

A few years ago I conducted a study of employee engagement at twenty U.S. hospitals. They were the top and bottom ten in employee engagement rankings from a national sample, provided to me by the research firm Quantum Workplace. 

What differentiated the top 10 hospitals from the bottom 10? My analysis revealed that employees at the highest-scoring hospitals are more likely to have:

• A strong feeling that the senior leadership of the hospital is committed to making it a great place to work and truly values employees as their most important resource,
• Confidence in the organization’s future success and an understanding of how the employees contribute to that success,
• Open and honest communication between employees and managers,
• A sense that the hospital is committed to investing in employees, an investment that will help them develop their careers,
• Opportunities for employees to be recognized when they contribute to the organization’s success,
• Fair pay for their contributions, and
• Benefits that are not perceived as typical of other organizations.

An employee at a bottom ten hospital summarized how she believes the culture where she works impacts the health and safety of patients:

Employee morale is reflected daily in patient care. I work on a unit where our director does not know our names, or interact with us. Although she is a nice person, her personality comes off as uncaring. This creates anger and frustration on the unit with the staff which creates less caring behavior for our patients. If the hospital wants its retention rate to increase or stabilize, they need to take the time to ensure that employees are well taken care of, and that their needs are being met.

These studies point to the same challenge-the culture of a hospital can impact patient mortality. Having honest discussions about hospital culture needs to occur more frequently and steps should be taken to build a more engaging, healthier culture.

Patient lives depend on it.