MHA 542 Week 4 Creating and Adjusting Organizational Culture Example

Culture Is What the Cath Lab Does at 2 A.M.: Leading a Guiding Coalition to Change the Culture Behind a Heart Program's Results

[Student Name]

University of Phoenix

MHA/542: Leading with Authenticity in the Health Sector

Week 4 Assignment

[Instructor Name]

[Date]

The medical center, its heart program, survey results and coalition are composites written for a model paper; research findings come from the sources cited.

The medical center's chief operating officer reviewed the latest federal quality data for the heart program in March. Thirty-day risk-standardized mortality for patients treated for heart attack had risen over three years to above the national rate. The cardiologists were skilled and the equipment was modern. She suspected the problem lay in how people worked together. This paper describes how she assessed and set out to change the culture of the heart program.

What Culture Is

Organizational culture is the shared assumptions, values and habits that shape how people behave, especially when rules do not dictate the answer. It shows in whether a nurse questions a cardiologist at 2 a.m., whether problems are discussed openly and whether leaders are seen on the units.

Assessing the Culture

She used three sources. A culture survey of heart program staff showed low scores on communication openness and on feeling safe to raise concerns. Interviews with twenty staff members described a hierarchy in which nurses and technicians rarely questioned physicians and problems were handled quietly. Observation of the cardiac catheterization laboratory at night found little structured communication at handoffs.

Linking Culture to Outcomes

The case for change depended on showing that culture affects outcomes. A two-year intervention study in ten hospitals worked to shift culture in the care of patients with heart attack. Culture changed significantly across the sample, especially in learning environment and senior management support, and six hospitals achieved substantial culture change. Those six reduced risk-standardized mortality by 1.07 percentage points, compared with 0.23 points in the four hospitals that changed less (Curry et al., 2018). Hospitals that changed how people worked together saw fewer heart attack patients die.

What Successful Hospitals Did

A companion analysis of the same hospitals found that those with the greatest success had guiding coalitions that effectively included staff from different disciplines and levels of the hierarchy, authentic participation in the coalition's work and distinct patterns of managing conflict; coalition size and turnover did not predict success (Bradley et al., 2018).

Forming the Guiding Coalition

The chief operating officer asked the heart program's medical director and nursing director to co-lead a coalition of fourteen members: two interventional cardiologists, a hospitalist, two catheterization laboratory nurses, a cardiac intensive care nurse, a technologist, an emergency physician, a paramedic from the regional ambulance service, a pharmacist, a quality analyst, a patient who had survived a heart attack and herself. Several members were chosen because they had been critical of how the program worked.

Authentic Participation

The coalition met every two weeks, with the co-leads rotating who spoke first so that nurses and technologists were heard before physicians. Decisions required agreement from members of at least three disciplines.

Managing Conflict

Early meetings were tense. A catheterization nurse described being told to stop questioning an order during a case; the cardiologist involved disputed her account. Rather than smoothing it over, the co-leads set norms: disagreements about care are expected, discussed on the merits and never punished. The coalition then worked through the case together and wrote a protocol for pausing a procedure when any team member has a safety concern.

Leadership Walk Rounds

A systematic review of strategies to improve safety culture found some evidence that leadership walk rounds and broader programs run at the unit level may improve patient safety climate, although studies were varied in quality (Morello et al., 2013). The chief operating officer began monthly walk rounds in the heart program, including two night rounds, asking staff what might cause the next patient harm and reporting back on what had been fixed.

Structured Case Reviews

Every heart attack death and serious complication is now reviewed monthly by the whole team, not only physicians, focusing on systems and communication rather than blame.

Changing Handoffs

The coalition introduced a structured handoff between the emergency department, catheterization laboratory and cardiac intensive care unit, with a checklist that any team member can stop to raise a concern.

Senior Leadership Support

Because the study identified senior management support as a key dimension, the chief operating officer attends one coalition meeting a month, secures resources the coalition requests and reports its progress to the board's quality committee.

Resistance

Two cardiologists viewed the effort as an implied criticism of their skill. The medical director met with them individually, shared the mortality data and invited them to lead the case review process. One accepted; the other remained skeptical but did not obstruct.

Artifacts That Signal Change

Culture shows in small things. The catheterization laboratory added the pause protocol to its whiteboard, case reviews began with a reminder that the purpose was learning and the chief operating officer's night rounds became known across the medical center. Staff noticed when a cardiologist publicly thanked a technologist who had stopped a case to raise a concern about a patient's allergy. Stories like that spread faster than any memo.

Aligning Systems With the Culture

Culture change fails when systems reward the old behavior. The heart program's physician performance reviews had counted procedures but not teamwork; the medical director added peer feedback from nurses and technologists. Nursing evaluations began to include speaking up about safety as a valued behavior. Hiring interviews for the program now ask candidates how they have handled disagreement with someone more senior.

Early Signs

After six months, the heart program's safety event reports had risen by a third, most of them near misses, and the repeat culture survey showed modest gains on communication openness. Door-to-balloon times had improved as handoffs became more structured. Mortality data lag and will take longer to show whether the changes matter for patients.

Measuring Culture and Outcomes

The culture survey will be repeated annually, with targets for communication openness and speaking up. Outcome measures include risk-standardized heart attack mortality, door-to-balloon times and complications. Results are shared with all heart program staff.

Beyond the Heart Program

The chief operating officer saw the heart program as a pilot. If the coalition model worked, she planned to use it in the emergency department and surgical services, where culture surveys showed similar gaps. Lessons from the first coalition, including how to handle conflict and include front-line staff, would be written down so that later coalitions could start faster.

A Realistic Time Frame

Culture changes slowly. The plan runs two years, matching the study's time frame, with milestones at six, twelve and twenty-four months.

Conclusion

The heart program's results were being shaped by a culture in which people did not speak up. Research linking culture change to lower heart attack mortality and identifying what successful guiding coalitions do shaped a plan built on a diverse coalition, authentic participation, honest conflict, leadership walk rounds and structured reviews. Culture is what the team does at 2 a.m., and changing it requires leaders to be present, to listen and to measure.

References

Bradley, E. H., Brewster, A. L., McNatt, Z., Linnander, E. L., Cherlin, E., Fosburgh, H., Ting, H. H., & Curry, L. A. (2018). How guiding coalitions promote positive culture change in hospitals: A longitudinal mixed methods interventional study. BMJ Quality & Safety, 27(3), 218-225. https://doi.org/10.1136/bmjqs-2017-006574

Curry, L. A., Brault, M. A., Linnander, E. L., McNatt, Z., Brewster, A. L., Cherlin, E., Flieger, S. P., Ting, H. H., & Bradley, E. H. (2018). Influencing organisational culture to improve hospital performance in care of patients with acute myocardial infarction: A mixed-methods intervention study. BMJ Quality & Safety, 27(3), 207-217. https://doi.org/10.1136/bmjqs-2017-006989

Morello, R. T., Lowthian, J. A., Barker, A. L., McGinnes, R., Dunt, D., & Brand, C. (2013). Strategies for improving patient safety culture in hospitals: A systematic review. BMJ Quality & Safety, 22(1), 11-18. https://doi.org/10.1136/bmjqs-2011-000582