ArticleBMJ quality & safety2018
How guiding coalitions promote positive culture change in hospitals: a longitudinal mixed methods interventional study.
Article in BMJ quality & safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Collective leadership to improve professional practice, healthcare outcomes and staff well-being.The Cochrane database of systematic reviews · 2022Pooled it
- Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies.BMJ quality & safety · 2019Pooled it
- The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings.Journal of general internal medicine · 2021Trial
- Association Between Organizational Culture and Emergency Medical Service Clinician Turnover.International journal of environmental research and public health · 2025Article
- 'We listened and supported and depended on each other': a qualitative study of how leadership influences implementation of QI interventions.BMJ quality & safety · 2025Article
- Fair Healthcare Practices in Orthopedics Assessed with a New Framework.Healthcare (Basel, Switzerland) · 2023Article
- Tackling change in mental health service delivery: A qualitative evaluation of a lifestyle program targeting mental health staff - Keeping our Staff in Mind (KoSiM).Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals · 2023Article
- Leading change in practice: how "longitudinal prebriefing" nurtures and sustains in situ simulation programs.Advances in simulation (London, England) · 2023Article
- Continuous quality improvement at the frontline: One interdisciplinary clinical team's four-year journey after completing a virtual learning program.Learning health systems · 2022Article
- Mitigating structural racism to reduce inequities in sepsis outcomes: a mixed methods, longitudinal intervention study.BMC health services research · 2022Article
- Maintaining Implementation through Dynamic Adaptations (MIDAS): protocol for a cluster-randomized trial of implementation strategies to optimize and sustain use of evidence-based practices in Veteran Health Administration (VHA) patients.Implementation science communications · 2022Article
- Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation.BMJ quality & safety · 2021Article
- Changing hospital organisational culture for improved patient outcomes: developing and implementing the leadership saves lives intervention.BMJ quality & safety · 2021Article
- Increasing risk-concordant cardiovascular care in diverse health systems: a mixed methods pragmatic stepped wedge cluster randomized implementation trial of shared decision making (SDM4IP).Implementation science communications · 2021Article
- Association Between Implementing Comprehensive Learning Collaborative Strategies in a Statewide Collaborative and Changes in Hospital Safety Culture.JAMA surgery · 2020Article
- Diversity, Inclusive Leadership, and Health Outcomes.International journal of health policy and management · 2020Article
- Article
- Association Between Hospital Safety Culture and Surgical Outcomes in a Statewide Surgical Quality Improvement Collaborative.Journal of the American College of Surgeons · 2019Article
- The influence of hospital accreditation: a longitudinal assessment of organisational culture.BMC health services research · 2019Article
- A mixed-methods evaluation of the MOREBMC health services research · 2019Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundQuality collaboratives are widely endorsed as a potentially effective method for translating and spreading best practices for acute myocardial infarction (AMI) care. Nevertheless, hospital success in improving performance through participation in collaboratives varies markedly. We sought to understand what distinguished hospitals that succeeded in shifting culture and reducing 30-day risk-standardised mortality rate (RSMR) after AMI through their participation in the Leadership Saves Lives (LSL) collaborative. PROCEDURES: We conducted a longitudinal, mixed methods intervention study of 10 hospitals over a 2-year period; data included surveys of 223 individuals (response rates 83%-94% depending on wave) and 393 in-depth interviews with clinical and management staff most engaged with the LSL intervention in the 10 hospitals. We measured change in culture and RSMR, and key aspects of working related to team membership, turnover, level of participation and approaches to conflict management. MAIN
findingsThe six hospitals that experienced substantial culture change and greater reductions in RSMR demonstrated distinctions in: (1) effective inclusion of staff from different disciplines and levels in the organisational hierarchy in the team guiding improvement efforts (referred to as the 'guiding coalition' in each hospital); (2) authentic participation in the work of the guiding coalition; and (3) distinct patterns of managing conflict. Guiding coalition size and turnover were not associated with success (p values>0.05). In the six hospitals that experienced substantial positive culture change, staff indicated that the LSL learnings were already being applied to other improvement efforts. PRINCIPAL
conclusionsHospitals that were most successful in a national quality collaborative to shift hospital culture and reduce RSMR showed distinct patterns in membership diversity, authentic participation and capacity for conflict management.
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