This Article Full Text Full Text (PDF) All Versions of this Article: 40/10/3390    most recent STROKEAHA.109.559492v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by van Wijngaarden, J. D.H. PubMed PubMed Citation Articles by van Wijngaarden, J. D.H. Related Collections Acute Cerebral Infarction Emergency treatment of Stroke Thrombolysis

(Stroke. 2009;40:3390.)
© 2009 American Heart Association, Inc.

Research Letters

Hospital Rates of Thrombolysis for Acute Ischemic Stroke

The Influence of Organizational Culture

Jeroen D.H. van Wijngaarden, PhD; Maaike Dirks, MD; Robbert Huijsman, PhD; Louis W. Niessen, MD, PhD; Isabelle N. Fabbricotti, PhD; Diederik W.J. Dippel, MD, PhD the Promoting Acute Thrombolysis for Ischaemic Stroke (PRACTISE) Investigators

From the Institute for Health Policy and Management (J.D.H.v.W., R.H., L.W.N., I.N.F.) and the Department of Neurology (M.D., D.W.J.D.), Erasmus MC University Hospital, Rotterdam, The Netherlands; and the Department of International Health (L.W.N.), Johns Hopkins Medical Institutions, Baltimore, Md.

Correspondence to Jeroen D.H. van Wijngaarden, PhD, Institute of Health Policy and Management, Erasmus University Rotterdam, Jeroen van Wijngaarden, PO Box 1738, 3000 DR Rotterdam, The Netherlands. E-mail j.vanwijngaarden{at}erasmusmc.nl

Background and Purpose— 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.

Key Words: coordination • mixed methods • organizational culture • outcomes • stroke management