Heart attack survival better when hospital leaders are engaged

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A new Yale University study has identified factors that may determine why the mortality rates related to heart attacks are higher in some hospitals than others--even when adjusted for patient severity.

Earlier research in this area has revealed little about the factors that may influence the variation in death rates, the researches say in the March issue of the Annals of Internal Medicine. To get a clearer picture, the Yale team reviewed 11 hospitals through interviews and site visits--selecting among the best and worst performers as rated by the Centers for Medicare and Medicaid Services.

The researchers found that hospitals in the high- and low-performing groups differed greatly in five ways: organizational values and goals, senior management involvement, broad staff presence and expertise in heart attack care, communication and coordination, and problem solving.

"Our research shows that the key facets to safety and quality in hospitals may not be new gadgets," Elizabeth Bradley, PhD, faculty director at the Yale Global Health Leadership Institute and senior author on the paper, said in a statement.

Staff in the best-performing hospitals reported that strong communication and coordination existed across all disciplines and departments. In lower performing hospitals, sporadic involvement of senior management was a common reason cited. This was related in part to frequent turnovers and the inability of management to create an environment that encouraged taking responsibility for performance problems.

"The essential ingredients are not expensive. If we could implement our findings in more hospitals, we could improve quality without adding to costs," Bradley said.

For more details:
- here's the study abstract
- view the Yale University release

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