Increasing the Relevance Increasing the Relevance of Health Care of Health Care

Organizational ResearchOrganizational Research

Jeff Alexander, Ph.D.Jeff Alexander, Ph.D.

AHRQ Annual MeetingAHRQ Annual Meeting

Sept 8, 2008Sept 8, 2008

The ProblemThe Problem

Evidence-Based Management (EBM) Evidence-Based Management (EBM) is the systematic application of the is the systematic application of the best available evidence, particularly best available evidence, particularly well-conducted management well-conducted management research, to the evaluation of research, to the evaluation of managerial strategies for improving managerial strategies for improving the performance of health services the performance of health services organizations. organizations.

gap exists between this ideal and the gap exists between this ideal and the current state of the art in evidence-current state of the art in evidence-based managementbased management articles are often inaccessible articles are often inaccessible Focus on research, not practice Focus on research, not practice

implications implications ‘‘popular’ management books and journals popular’ management books and journals

confuse the issueconfuse the issue Research timeframe makes info obsoleteResearch timeframe makes info obsolete

AHRQ StudyAHRQ Study

What new data/variables should be What new data/variables should be added to the HCUP data to increase added to the HCUP data to increase capacity for organization and capacity for organization and management research?management research?

Interviews with hospital and health Interviews with hospital and health system leaderssystem leaders

Interviews with leading researchersInterviews with leading researchers Critical review of the literatureCritical review of the literature

FindingsFindings

research evidence is not consistent with research evidence is not consistent with the problems and decision-making the problems and decision-making conditions faced by those who might conditions faced by those who might utilize this evidence. utilize this evidence.

results of this study reveal not just gaps, results of this study reveal not just gaps, but a chasm between what healthcare but a chasm between what healthcare executives are concerned about in their executives are concerned about in their daily practices and what health service daily practices and what health service research could have offeredresearch could have offered. .

ContentContent

Evidence is lacking in a number of areas Evidence is lacking in a number of areas that are of top priorities to managersthat are of top priorities to managers safe staffing level and optimal skill mix safe staffing level and optimal skill mix eliminating practice variationeliminating practice variation cost and quality effects of different IT cost and quality effects of different IT

systems systems Cost-benefit of medical technologyCost-benefit of medical technology what constitutes effective organizational what constitutes effective organizational

culture and leadership culture and leadership

ApproachApproach

Hospital CEOs view cost, quality, and Hospital CEOs view cost, quality, and efficiency as inextricably linked efficiency as inextricably linked

Hospital CEOs think about Hospital CEOs think about organizational factors systemically, organizational factors systemically, not individually not individually

Hospital CEOs emphasized process Hospital CEOs emphasized process related factors rather than structural related factors rather than structural drivers of cost, quality, and efficiency. drivers of cost, quality, and efficiency.

Are We Asking the Right Are We Asking the Right Questions?Questions?

All organizations are not alikeAll organizations are not alike Middle ground between individually Middle ground between individually

tailoring approaches and one size fits tailoring approaches and one size fits all formulasall formulas Conditional effects of strategies, Conditional effects of strategies,

innovations, or changesinnovations, or changes

Meeting Customer NeedsMeeting Customer Needs

Practice leaders do not consider health Practice leaders do not consider health services research a part of their information services research a part of their information armamentariumarmamentarium improved understanding of the cognitive maps improved understanding of the cognitive maps

that managers use in both defining problems and that managers use in both defining problems and developing solutions developing solutions

what are the decision-making constraints faced what are the decision-making constraints faced by managers? What criteria form the basis for by managers? What criteria form the basis for selecting among alternative strategies? How are selecting among alternative strategies? How are particular solutions adapted to fit different particular solutions adapted to fit different circumstances? circumstances?

OpportunitiesOpportunities

How can systems of accountability be How can systems of accountability be designed to ensure adequate designed to ensure adequate coordination across organizational coordination across organizational boundaries and providers of care ?boundaries and providers of care ?

How can clinical teams be organized and How can clinical teams be organized and led to achieve better results for patients?led to achieve better results for patients?

What are the organizational and behavior What are the organizational and behavior responses to different incentive responses to different incentive programs such as P4P ?programs such as P4P ?

OpportunitiesOpportunities

How can organizations promote the How can organizations promote the diffusion, implementation and diffusion, implementation and sustainability of new, evidence sustainability of new, evidence based practices?based practices?

Are new care models effective in Are new care models effective in terms of improving quality, and terms of improving quality, and efficient in terms of reducing costs efficient in terms of reducing costs (patient centered medical home)(patient centered medical home)

Threats and BarriersThreats and Barriers

Timing Timing Formulating our problems in isolation Formulating our problems in isolation Insufficient interdisciplinary researchInsufficient interdisciplinary research traditional structures and incentive traditional structures and incentive

systems in universities systems in universities Funding Funding

Data IssuesData Issues

Existing data does not address many of Existing data does not address many of the problems managers regard as the problems managers regard as importantimportant

Structure not processStructure not process primary data collectionprimary data collection small sample sizes small sample sizes perceived lack of generalizability of perceived lack of generalizability of

findings findings

EVIDENCE-BASED PRACTICEEVIDENCE-BASED/

RESEARCH-TESTED/EFFECTIVE PRACTICES

INFORMED HEALTH SERVICES

DECISION-MAKING

How do we improve capacity of providers to use research to best deliver care to consumers/patients?

How do we improve uptake of practices demonstrated to improve consumer/ patient outcomes?

INTEGRATION INTEGRATION

2 Models that Work2 Models that Work

Center for Health Management Center for Health Management Research Research

Accelerating Change and Accelerating Change and Transformation in Organizations and Transformation in Organizations and Networks (ACTION) Networks (ACTION)