Attributes of Hospitals with the Best Acute Myocardial Infarction Outcomes

Mortality rates after acute myocardial infarction (AMI), even when adjusted for disease severity, vary considerably among U.S. hospitals. To identify hospital factors associated with this variability, investigators studied 11 U.S. hospitals that ranked either in the top or the bottom 5% for risk-standardized AMI mortality over two consecutive periods (2005–2006 and 2006–2007). The hospitals ranged widely in size, geographic location, and socioeconomic conditions. Research teams conducted site visits and in-depth interviews.

Qualitative analysis yielded six domains of hospital characteristics, five of which showed marked differences between high- and low-performing hospitals.

1. Hospital protocols and processes of AMI care: No discernible difference between high- and low-performing hospitals emerged in this domain.

2. Organizational values and goals: Staff at high-performing hospitals articulated shared organizational values regarding the provision of exceptionally high-quality care. At low-performing hospitals, staff did not clearly convey a common vision of excellence.

3. Senior management involvement: Executives and governing boards at high-performing hospitals were committed to providing adequate financial and nonfinancial resources for excellent AMI care, whereas senior management involvement was sporadic in low-performing hospitals.

4. Broad staff presence and expertise: In high-performing hospitals, staff described physician champions, empowered nurses, involved pharmacists, and high standards required of all staff. Staff involvement in quality improvement was limited or absent in low-performing hospitals.

5. Communication and coordination: At high-performing hospitals, communication and coordination were strong across both disciplines and departments, whereas poor structural supports hampered the flow of information at low-performing hospitals.

6. Problem solving and learning: At high-performing hospitals, staff described problem solving and organizational learning as routine and positive experiences, whereas staff at low-performing hospitals reported scant use or very recent implementation of formal problem-solving methods.