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Leslie Curry

PhD, MPH, BA
Professor of Public Health (Health Policy) and Professor of Management; Lecturer, Yale College; Associate Director Yale Scholars in Implementation Science Training Program

Research Summary

Dr. Curry’s research focuses on organizational culture, leadership, management and performance in health care systems in the US and internationally. She is an internationally recognized expert in the use of qualitative and mixed methods in public health and health services research. Dr. Curry has two decades of experience in health policy and program implementation and evaluation in collaboration with government agencies and policymakers with a primary objective of informing the development and scale up of innovative health programs and policy.

She serves on a number of editorial boards including the Journal of Mixed Methods, is a fellow in the Gerontological Society of America, and a member of Academy Health. She is also an elected member of AcademyHealth Methods Council and served as a Board Member of the Mixed Methods International Research Association.

Specialized Terms: Organizational culture and performance; Scale up of innovations; Social and health care spending

Extensive Research Description

Research interests include:

Innovation in hospital organizational culture and quality improvement. Leslie served as lead investigator for the first qualitative study demonstrating the importance of hospital organizational culture in performance in a clinical outcome, acute myocardial infarction (AMI) mortality. The paper drew international attention with more than 36,850 hits on the Annals of Internal Medicine website, 232 citations to date and more than 40 news stories nationally. It was foundational to the first prospective longitudinal intervention study directed at influencing organizational culture in hospitals with the goal of improving evidence-based practices and outcomes for patients hospitalized with AMI.

Development of a positive deviance approach to improve health outcomes. Together with colleagues Elizabeth Bradley and Harlan Krumholz, Leslie collaborated in the development and application of a positive deviance approach to improving health outcomes. The positive deviance approach addresses limitations of biomedical, epidemiological, quality improvement and action research combining intensive organizational-level examination using qualitative methods with the broader-scale statistical analysis possible with a large sample of organizations. The approach allows for the explicit integration of real-life implementation issues and organizational context because it seeks to characterize not just what processes and practices are present in top performing organizations but also the context in which they are implemented. This approach takes advantage of natural variation in performance, develops an evidence base through detailed organizational analysis and statistical testing of hypotheses, and supports collaboration between researcher and practitioner in ways that identify feasible solutions and foster support for dissemination and uptake of recommendations. Their paper in Implementation Science is classified as “highly accessed” (currently cited 252 times); Leslie and colleagues are now applying the method at the community level.

Evaluation of large-scale, complex programs and interventions. Leslie has more than 20 years of experience evaluating complex health care financing and delivery programs and interventions in the US and internationally. Illustrative policies, programs and interventions include: The Partnership for Long Term Care Insurance, Money Follows the Person Rebalancing Program, Senior Care Options Program, The Patient Self Determination Act. Recent projects include Project Last Mile, a multi-country effort to translate the supply chain and logistics expertise of the Coca-Cola system to public sector medical supply chain organizations across Africa, and a realist evaluation of the Mesoamerica Salud Mesoamerica Initiativw, a large-scale,multi-country program that uses supply-side financial incentives directed at the central-level of governments, and evaluation of public, health sector performance to induce improvements in primary care performance in eight low and middle-income countries.

Cross-organization and cross-sector collaborations to care for high need, high cost populations: 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. As part of a multidisciplinary team at Yale, our recent work 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. Current work investigates the role of Area Agencies on Aging as a mechanism for cross-sector partnerships in high-performing communities.

Internationally recognized expertise in qualitative and mixed methods in health sciences: Expertise includes: 1) lead author on qualitative and mixed methods textbooks commissioned by Sage Publications (2014) and the American Public Health Association (2006); 2) elected member of 9-person governing board of the Mixed Methods International Research Association; 3) member of an advisory committee appointed by the Office of Behavioral and Social Sciences Research at the National Institutes of Health charged with defining best practices in mixed methods research; 4) co-PI on a series of grants awarded by the National Institute on Aging, the Robert Wood Johnson Foundation and the John A Hartford Foundation designed to enhance the rigor and credibility of qualitative and mixed methods in health research; 5) ad hoc reviewer on the Health Services, Organization and Delivery study section for qualitative and mixed methods proposals; 6) regularly invited speaker in national and international settings, including as the keynote address at the International Conference on Mixed Methods in Harrogate, UK (2009); and 7) editorial board member and regular reviewer for top tier peer-reviewed journals.

Illustrative projects:

Effective Partnership Strategies in Area Agencies on Aging to Improve Health Outcomes

Leadership Save Lives, Culture Change in US Hospitals to Improve Performance in AMI Care, The Medicines Company

Diffusion, Dissemination, and Widespread Take Up: What Works? Gates Foundation

All-Cause Hospital Readmission Rates for Patients with Heart Failure and Acute Myocardial Infarction: What Hospital Practices Make a Difference and How Are They Adopted? Commonwealth Fund

Ethiopian Millennium Rural Initiative External Evaluation, Clinton Health Access Initiative and Children's Investment Fund Foundation

Strategies for Reducing Mortality after Acute Myocardial Infarction Evidence-Based Approaches to Improving Quality, AHRQ and United Health Care Foundation

Coauthors

Research Interests

Health Policy; Public Health; Quality of Health Care; Social Sciences; Global Health; Health Care

Public Health Interests

Global Health; Health Care Quality, Efficiency; Health Care Management; Health Policy; Health Systems Reform

Research Images

Selected Publications