Hospital rates of thrombolysis for acute ischemic stroke: The influence of organizational culture
Background and Purpose-: The purpose of this study was to determine if organizational culture explains differences in rates of intravenous thrombolysis for acute ischemic stroke between different hospitals. Methods-: A cohort study was done in 12 centers admitting 5515 consecutive patients with acute stroke in The Netherlands. A multilevel logistic regression model was used to relate the likelihood of treatment with thrombolysis to characteristics of the organizational culture of the centers. Organizational culture was defined by 10 characteristics and scored by a panel. A sum score was created by adding all scores and dividing by 10. Results-: Thrombolysis rates varied from 5.7% to 21.7%. We observed an association between thrombolysis and the availability of informal and formal feedback (OR, 1.18; 95% CI, 1.09 to 1.28); a learning culture (OR, 1.12; 95% CI, 1.02 to 1.23); uncompromising, individual clinical leadership (OR, 1.12; 95% CI, 1.03 to 1.23); explicit goals (OR, 1.08; 95% CI, 1.01 to 1.17); and with the sum score (OR, 1.12; 95% CI, 1.02 to 1.23). Conclusions-: Several cultural characteristics of the hospital organization are related to thrombolysis rate. Organizational culture may be an important target for interventions aimed at increasing rates of thrombolysis for acute ischemic stroke in hospitals.
|Keywords||Coordination, Mixed methods, Organizational culture, Outcomes, Stroke management, alteplase, article, blood clot lysis, cerebrovascular accident, controlled study, hospital charge, human, major clinical study, medical education, organization, patient care, priority journal, treatment outcome|
|Persistent URL||dx.doi.org/10.1161/STROKEAHA.109.559492, hdl.handle.net/1765/17952|
van Wijngaarden, J.D.H., Dirks, M., Huijsman, R., Niessen, L.W., Fabbricotti, I.N., & Dippel, D.W.J.. (2009). Hospital rates of thrombolysis for acute ischemic stroke: The influence of organizational culture. Stroke, 40(10), 3390–3392. doi:10.1161/STROKEAHA.109.559492