GHLI in the United States

Hospital Organizational Culture

Our GHLI research team is generating new evidence about leadership, management, and organizational culture in health care across diverse institutional and community settings in the United States.

A decade of GHLI research underpins national improvement in quality of cardiovascular care, including improvements in survival after acute myocardial infarction (AMI). We published the first qualitative study demonstrating the importance of hospital organizational culture in caring for patients with AMI. As a follow-on, we developed the first successful prospective longitudinal intervention study to influence hospital organizational culture and improve outcomes for patients hospitalized with AMI. In addition to publishing results in peer-reviewed journals, we collaborate with the American College of Cardiology and the Mayo Clinic Care Network in knowledge translation work to develop and disseminate practical tools for use by clinical and executive leadership nationally.

Social Determinants of Health

Beyond the hospital walls, increasing evidence demonstrates that services supporting social determinants of health can improve health and reduce health care costs for older adults, particularly older adults with complex health care needs. Our GHLI research focuses on the structure and nature of relationships among service providers in the health care and social service sectors. Outcomes of interest include hospital readmissions, avoidable nursing home use, and costs, and we are currently investigating the role of Area Agencies on Aging as a mechanism for cross-sector partnerships in high-performing communities.

Hospice, palliative care and end-of-life care

We also apply our expertise in positive deviance and mixed methods to quality of care in hospice, palliative care and end-of-life care. Recent projects have examined patterns of variation in referral and utilization patterns; and the impact of physician and nurse communication with patients and families.

• Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. E. H. Bradley, L. A. Curry, E. S. Spatz, J. Herrin, E. J. Cherlin, J. P. Curtis, J. W. Thompson, H. H. Ting, Y. Wang and H. M. Krumholz; Ann Intern Med 2012; 156:618-26.
• Cross-Sectoral Partnerships By Area Agencies On Aging: Associations With Health Care Use And Spending. A. L. Brewster, S. Kunkel, J. Straker and L. A. Curry; Health Aff (Millwood) 2018; 37:15-21.
• Interventions for Reducing Hospital Readmission Rates: The Role of Hospice and Palliative Care. E. J. Cherlin, A. L. Brewster, L. A. Curry, M. E. Canavan, R. Hurzeler and E. H. Bradley; Am J Hosp Palliat Care 2017; 34:748-753.
• Health Hot Spots: Mapping Hospital Costs and Social Determinants of Health. J. Holzer, M. Canavan, E. Cherlin and E. Bradley; Open Journal of Preventive Medicine 2014; 04:717-722.
• Impact of social service and public health spending on teenage birth rates across the USA: an ecological study. H. L. Sipsma, M. Canavan, M. Gilliam and E. Bradley; BMJ Open 2017; 7:e013601.
• Spending on social and public health services and its association with homicide in the USA: an ecological study. H. L. Sipsma, M. E. Canavan, E. Rogan, L. A. Taylor, K. M. Talbert-Slagle and E. H. Bradley; BMJ Open 2017; 7:e016379.
• US hospice industry experienced considerable turbulence from changes in ownership, growth, and shift to for-profit status. J. W. Thompson, M. D. Carlson and E. H. Bradley; Health Aff (Millwood) 2012; 31:1286-93.
• Geographic Variation of Hospice Use Patterns at the End of Life. S. Y. Wang, M. D. Aldridge, C. P. Gross, M. Canavan, E. Cherlin, R. Johnson-Hurzeler and E. Bradley; J Palliat Med 2015; 18:771-80.