Hospital rates of thrombolysis for acute ischemic stroke: the influence of organizational culture.
OBJECTIVE
The purpose of this study was to determine if organizational culture explains differences in rates of intravenous thrombolysis for acute ischemic stroke between different hospitals.


METHODS
A cohort study was done in 12 centers admitting 5515 consecutive patients with acute stroke in The Netherlands. A multilevel logistic regression model was used to relate the likelihood of treatment with thrombolysis to characteristics of the organizational culture of the centers. Organizational culture was defined by 10 characteristics and scored by a panel. A sum score was created by adding all scores and dividing by 10.


RESULTS
Thrombolysis rates varied from 5.7% to 21.7%. We observed an association between thrombolysis and the availability of informal and formal feedback (OR, 1.18; 95% CI, 1.09 to 1.28); a learning culture (OR, 1.12; 95% CI, 1.02 to 1.23); uncompromising, individual clinical leadership (OR, 1.12; 95% CI, 1.03 to 1.23); explicit goals (OR, 1.08; 95% CI, 1.01 to 1.17); and with the sum score (OR, 1.12; 95% CI, 1.02 to 1.23).


CONCLUSIONS
Several cultural characteristics of the hospital organization are related to thrombolysis rate. Organizational culture may be an important target for interventions aimed at increasing rates of thrombolysis for acute ischemic stroke in hospitals.
van Wijngaarden
Jeroen D H
JD
Dirks
Maaike
M
Huijsman
Robbert
R
Niessen
Louis W
LW
Fabbricotti
Isabelle N
IN
Dippel
Diederik W J
DW
D000208:Acute Disease / Q000628:therapy; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy*; D015331:Cohort Studies; D004502:Education, Medical, Continuing / Q000706:statistics & numerical data / Q000639:trends; D004632:Emergency Medical Services / Q000706:statistics & numerical data / Q000639:trends; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019983:Guideline Adherence / Q000706:statistics & numerical data / Q000639:trends; D006757:Hospital Units / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007398:Interpersonal Relations; D020767:Intracranial Thrombosis / Q000188:drug therapy*; D008875:Middle Aged; D009426:Netherlands; D015279:Organizational Culture; D019555:Physician-Nurse Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends; D011787:Quality of Health Care / Q000706:statistics & numerical data / Q000639:trends; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator