Researchers have identified the key factors K that help hospitals treat heart attack patients as quickly as possible.

The Study

"In order to understand what makes great places great, you have to get on the ground and talk to people to learn how they achieve things that are beyond the reach of other places," says Dr. Harlan J. Krumholz, lead researcher and a professor of medicine at Yale University School of Medicine's Health Management Program. "When we look at large numbers, we often miss what we can learn by talking to a very small number of places to find out what they are doing."

For this reason, Krumholz's study focused on just 11 hospitals that were able to consistently restore blood flow to damaged hearts in 90 minutes or less.

The hospitals were not identified in the study, but they are all listed in a national registry of heart attack treatment. And despite some major differences among them-for example, one had 111 beds; another had 870-what they did have in common was getting heart attack patients artery-opening balloon angioplasty very quickly. Time-to-treat ranged from an average of just 55.5 minutes at one hospital to 87 at another.

Common Characteristics

The researchers found that these hospitals shared eight characteristics...

Commitment to the explicit goal of providing the fastest treatment possible.

Support from senior management.

Innovative protocols.

Flexibility to change protocols if it becomes necessary.

Uncompromising leaders.


Quick data retrieval to identify problems.

An organizational culture that could learn from its mistakes.

Most surprising to Elizabeth H. Bradley, director of the Yale Health Management Program as well as a member of the research team, was the give-and-take between the team leaders and the team members.

"In every organization there are conflicts," Bradley says. "These organizations were able to balance two things-intense data feedback, but in a blame-free way that could allow changes in rigid protocols."

The common denominator in all the hospitals was "amazing people who are so devoted," Bradley says. "There were a lot of impressive leaders, but also impressive team members."

The Next Step

The research group now is working with national organizations to translate the findings into action that can help improve hospital performance everywhere, Krumholz says.

"'We are in the midst of developing a national campaign by the American College of Cardiology," Krumholz says, with educational materials for hospitals across the country.

However, simply providing a set of instructions is not enough, Bradley cautions. "You need a whole cultural commitment to making these changes, and that takes a lot more than what you do when you read a book," she says.

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