3-How Culture Contributes to Health Care Value Delivery

MODULE 8 | Section 3 of 11

How Culture Contributes to Health Care Value Delivery

A CULTURE OF WASTE

Over the past few years, a number of resources–guidelines, algorithms, recommendations–have proliferated to support the delivery of high-value care. This is necessary, however it is not sufficient to result in real sustainable changes. This is because largely the gap is not about knowledge of what to do, but rather related to the prevailing influence of medical culture that surrounds each of us. In other words, we know what we should be doing, but the cultures in many of our organizations don’t promote or encourage this.

 

The current prevailing culture in medicine contributes to widespread overuse. For example, a survey study showed that 97% of emergency medicine physicians report they order unnecessary advanced imaging tests (CTs and MRIs), not because they do not recognize they are unnecessary, but rather mostly due to a cultural response to uncertainty1–just as we saw in the “story from the frontlines” video.

ORGANIZATIONAL CULTURE

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Research focusing on culture of group practices and other smaller units argues that as medical groups adapt to changes driven by health care reform, their success will depend on their cultures.2

WHAT INFLUENCE CAN CULTURE HAVE?

Organizational culture was the key factor distinguishing hospitals with high and low 30-day mortality rates for patients with acute myocardial infarction. Hospitals had similar evidence-based protocols and processes, but what really made the difference was their culture and how staff worked together to implement these processes to care for patients.3
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CULTURE’S IMPACT ON COMMUNICATION

Studies, including a systematic review (Braithwaite et al, 2017), found consistent associations between postive organizational culture and outcomes. This includes mortality and attitudes toward patient recommendations.4,5
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ADDITIONAL RESOURCES

“Influence of Institutional Culture and Policies on Do-Not-Resuscitate Decision Making at the End of Life”

Institutional culture and policies seem to affect whether medical trainees feel compelled to offer the choice of resuscitation in all clinical situations regardless of whether they believe it is clinically appropriate.

Dzeng E, Colaianni A, Roland M, et al. JAMA Internal Medicine. 2015 May;175(5):812-819.

AT THIS POINT YOU MAY BE WONDERING...

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“Most anthropologists would define culture as the shared set of (implicit and explicit) values, ideas, concepts, and rules of behavior that allow a social group to function and perpetuate itself.”6

 

Culture is simply “the way we do things around here” – Lundy & Cowling, 19967

 

Despite “culture” having what could seem like a diffuse, or squishy, definition, it turns out that aspects of culture can be defined, measured, tracked, and intervened upon. This will be explored in the coming sections.

Learn More

ARTICLE

Read about the factors that influence residents to order unnecessary tests in this study of internal medicine and general surgery residents.
Sedrak MS, Patel MS, Ziemba JB, et al. Journal of Hospital Medicine

ARTICLE

This study (done in Ireland but with generalizable findings) interviews healthcare leaders to find the impact of organizational culture on healthcare.
Camey M. International Journal of Health Care Quality Assurance

REFERENCES

  1. 1-Kanzaria HK, Hoffman JR, Probst MA, et al. Emergency physician perceptions of medically unnecessary advanced diagnostic imagingAcad Emerg Med. 2015;22(4):390-398.

 

  1. 2-Nembhard IM, Singer SJ, Shortell SM, Rittenhouse D, Cassalino LP. The cultural complexity of medical groupsHealth Care Manage Rev. 2012;37(3):200-213.

 

  1. 3-Curry LA, Spatz E, Cherlin E, et al. What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study. Ann Intern Med. 2011;(154(6):384-390

 

  1. 4-Braithwaite J, Herkes J, Ludlow K, Testa L, Lamprell G. Association between organizational and workplace cultures and patient outcomes: systematic reviewBMJ Open. 2017;7:e017708.

 

  1. 5-Dzeng E, Phil M, Colaianni A, Roland M, et al. Influence of institutional culture and policies on do-no-resuscitate decision making at the end of lifeJAMA Intern Med. 2015;175(5):812-819.

 

  1. 6-Hudelson PM. Culture and quality: an anthropological perspectiveInt J Qual Health C. 2004;16(5):345-346.

 

  1. 7-Lundy, O. and Cowling, A. (1996) Strategic Human Resource ManagementLondon: Routledge.

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