Evaluation of organizational culture among different levels of healthcare staff participating in the Institute for Healthcare Improvement's 100,000 Lives Campaign.
BACKGROUND
Little is known about how hospital organizational and cultural factors associated with implementation of quality initiatives such as the Institute for Healthcare Improvement's (IHI) 100,000 Lives Campaign differ among levels of healthcare staff.


METHODS
Evaluation of a mixed qualitative and quantitative methodology ("trilogic evaluation model").


METHODS
Six hospitals that joined the campaign before June 2006.


METHODS
Three strata of staff (executive leadership, midlevel, and frontline) at each hospital. RESULTS. Surveys were completed in 2008 by 135 hospital personnel (midlevel, 43.7%; frontline, 38.5%; executive, 17.8%) who also participated in 20 focus groups. Overall, 93% of participants were aware of the IHI campaign in their hospital and perceived that 58% (standard deviation, 22.7%) of improvements in quality at their hospital were a direct result of the campaign. There were significant differences between staff levels on the organizational culture (OC) items, with executive-level staff having higher scores than midlevel and frontline staff. All 20 focus groups perceived that the campaign interventions were sustainable and that data feedback, buy-in, hardwiring (into daily activities), and leadership support were essential to sustainability.


CONCLUSIONS
The trilogic model demonstrated that the 3 levels of staff had markedly different perceptions regarding the IHI campaign and OC. A framework in which frontline, midlevel, and leadership staff are simultaneously assessed may be a useful tool for future evaluations of OC and quality initiatives such as the IHI campaign.
Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, Georgia 30333, USA. rls7@cdc.gov
Ronda L
RL
Sinkowitz-Cochran
Amanda
A
Garcia-Williams
Andrew D
AD
Hackbarth
Bonnie
B
Zell
G Ross
GR
Baker
C Joseph
CJ
McCannon
Elise M
EM
Beltrami
John A
JA
Jernigan
L Clifford
LC
McDonald
Donald A
DA
Goldmann
D001291:Attitude of Health Personnel; D017144:Focus Groups; D005845:Georgia; D006761:Hospitals / Q000592:standards*; D006801:Humans; D015279:Organizational Culture; D010564:Personnel, Hospital; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D058996:Quality Improvement