What Distinguishes Top-Performing Hospitals in Acute Myocardial Infarction Mortality Rates? A Qualitative Study

Study Questions:

What are the key characteristics of hospitals that achieve optimal outcomes for patients with myocardial infarction (MI)?


The authors conducted site visits and detailed interviews with hospital staff at 11 hospitals that ranked in either the top or the bottom 5% in risk-standardized mortality rates for 2 years (2005-2007) per data from the Centers for Medicare & Medicaid Services.


Presence of guidelines, care protocols, and rapid response teams did not differentiate between high performing or poorly performing hospitals. The key identifying characteristics of the high performing hospitals related to institutional culture, with organizational values and goals aligned to provide high-quality care, senior management involvement in quality improvement and support for such efforts, dedicated physician champions and broad staff expertise in MI care, seamless communication and coordination among groups, and nonpunitive problem solving and learning.


The authors concluded that high performing hospitals are characterized by an organizational culture that supports improved MI care.


This study highlights that the outcomes of patients with acute MI are superior at hospitals with an institutional culture that values and supports high-quality care. These characteristics are difficult to quantify and much harder to track. Current performance measures focus on processes of care that almost all institutions are delivering in almost all the patients, and further improvement in outcome may need attention to hospital organization and culture.

Keywords: Hospitals, Quality Improvement, Myocardial Infarction, Medicare, Organizational Culture, United States

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