Changing Culture to Improve AMI Care | Cardiology Magazine

Acute myocardial infarction (AMI) is a very common condition, occurring once every 44 seconds in the U.S. alone. About 865,000 patients suffer from an AMI every year, resulting in approximately 200,000 deaths. Despite this frequency of occurrence, however, mortality rates for patients with AMI vary substantially from hospital to hospital. With the advent of public reporting on 30-day risk standardized mortality rate and its inclusion as a value-based purchasing metric, hospitals and care teams are increasingly interested in how to get this wide variance in check.

Enter the ACC’s newest quality initiative, Surviving MI. Research shows that a person’s chances of surviving a heart attack are dependent on factors like hospital culture, teamwork and leadership. A 2012 study published in Medical Care found that patients cared for in a hospital with a good versus a poor work environment were 7 percent less likely to be readmitted for heart failure and 6 percent less likely for heart attack. However, improving organizational culture can be daunting.

“Through Surviving MI, the ACC strives to make it easier for hospitals to take on this important challenge,” said Henry H. Ting, MD, FACC, chair of the Surviving MI Steering Committee. “In addition to providing evidence-based tools, strategies, and resources to assist with organizational learning, communications/collaboration, psychological safety and leadership, we are also facilitating the sharing of best practices through an online community of hospitals all working towards a common goal to pivot organizational culture.”

Surviving MI is built around seven evidence-based strategies. While studies have shown each of these strategies to be associated with an approximately 0.5 percent to 1 percent decrease in 30-day mortality rate, fewer than 10 percent of hospitals are consistently and routinely using at least four of these strategies.

“We found in our research that without a supportive organizational culture, specific technology and protocols are not always enough for improving performance in care. This is why Surviving MI focuses on this aspect of changing culture and adopting strategies that are associated with lower mortality rates for patients with AMI,” said Leslie Curry, PhD, co-chair of the Surviving MI Steering Committee.

Surviving MI is part of ACC’s Quality Improvement for Institutions program which brings together all of the College’s proven hospital quality improvement offerings under one umbrella. The goal of Surviving MI is to increase the adoption of evidence-based strategies associated with a lower risk standardized mortality rate for patients hospitalized with AMI through the creation of a hospital learning network. Although using the right medicines, diagnostic tests, stents, procedures and clinical protocols are important, recent studies show that leadership, culture, teamwork and communication are associated with lower mortality rates. Hospitals in this learning network focus on changing organizational culture to improve performance and have a lasting impact on patient outcomes.

Built on lessons learned from ACC quality initiatives, Door to Balloon Alliance and Hospital to Home, Surviving MI gives hospitals the opportunity to learn and network through webinars and community calls. Participants have access to online self-assessments and best practice toolkits, to build and implement a quality improvement project. Hospitals, especially those participating in the ACC’s NCDR ACTION Registry-GWTG which captures information on AMI patients, can track their progress, share lessons learned and ultimately foster a comprehensive learning network centered on reducing 30-day mortality. Participation in Surviving MI is free for NCDR participants.

“This initiative is unique in that it is one of the first to explicitly focus on patient outcomes and organizational culture change,” adds Ting. “What we learn from this effort may have additional benefit for other disease states, given that the changes sought affect the hospital organizational environment.”

More information about Surviving MI can be found on the Quality Improvement for Institutions website,

Cardiology Magazine

Keywords: Hospitals, Cooperative Behavior, Myocardial Infarction, Value-Based Purchasing, Diagnostic Tests, Routine, Organizational Innovation, Organizational Culture, Stents, Self-Assessment, Quality Improvement, Registries, Tolnaftate, Heart Failure, Clinical Protocols, Leadership, Cardiology Magazine, ACC Publications

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