Slide Presentation from the AHRQ 2008 Annual Conference
On September 8, 2008, Jeff Alexander, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (130 KB; Plugin Software Help).
Increasing the Relevance of Health Care Organizational Research
Jeff Alexander, Ph.D.
AHRQ Annual Meeting
Sept 8, 2008
- Evidence-Based Management (EBM) is the systematic application of the best available evidence, particularly well-conducted management research, to the evaluation of managerial strategies for improving the performance of health services organizations.
- Gap exists between this ideal and the current state of the art in evidence-based management.
- Articles are often inaccessible.
- Focus on research, not practice implications.
- 'Popular' management books and journals confuse the issue.
- Research timeframe makes info obsolete.
- What new data/variables should be added to the Healthcare Cost & Utilization Project (HCUP) data to increase capacity for organization and management research?
- Interviews with hospital and health system leaders.
- Interviews with leading researchers.
- Critical review of the literature.
- Research evidence is not consistent with the problems and decision-making conditions faced by those who might utilize this evidence.
- Results of this study reveal not just gaps, but a chasm between what healthcare executives are concerned about in their daily practices and what health service research could have offered.
- Evidence is lacking in a number of areas that are of top priorities to managers.
- Safe staffing level and optimal skill mix.
- Eliminating practice variation.
- Cost and quality effects of different information technology (IT) systems.
- Cost-benefit of medical technology.
- What constitutes effective organizational culture and leadership.
- Hospital Chief Executive Officers (CEOs) view cost, quality, and efficiency as inextricably linked.
- Hospital CEOs think about organizational factors systemically, not individually.
- Hospital CEOs emphasized process related factors rather than structural drivers of cost, quality, and efficiency.
Are We Asking the Right Questions?
- All organizations are not alike.
- Middle ground between individually tailoring approaches and one size fits all formulas.
- Conditional effects of strategies, innovations, or changes.
Meeting Customer Needs
- Practice leaders do not consider health services research a part of their information armamentarium.
- Improved understanding of the cognitive maps that managers use in both defining problems and developing solutions.
- What are the decision-making constraints faced by managers? What criteria form the basis for selecting among alternative strategies? How are particular solutions adapted to fit different circumstances?
- How can systems of accountability be designed to ensure adequate coordination across organizational boundaries and providers of care?
- How can clinical teams be organized and led to achieve better results for patients?
- What are the organizational and behavior responses to different incentive programs such as pay-for performance (P4P)?
- How can organizations promote the diffusion, implementation and sustainability of new, evidence based practices?
- Are new care models effective in terms of improving quality, and efficient in terms of reducing costs (patient centered medical home)?
Threats and Barriers
- Formulating our problems in isolation.
- Insufficient interdisciplinary research.
- Traditional structures and incentive systems in universities.
Existing data does not address many of the problems managers regard as important.
- Structure not process.
- Primary data collection.
- Small sample sizes.
- Perceived lack of generalizability of findings.
The flow chart shows the integration of "Evidence-Based Practice," which asks, "How do we improve the capacity of providers to use research to best deliver care to consumers/patients?", and "Evidence-Based/Research-Tested/Effective Practices," which asks, "How do we improve the uptake of practices demonstrated to improve consumer/patient outcomes?", into Informed Health Services and Decision-Making.
2 Models that Work
- Center for Health Management Research.
- Accelerating Change and Transformation in Organizations and Networks (ACTION).
Current as of January 2009
Increasing the Relevance of Health Care Organizational Research. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). January 2009.
Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualmtg08/090808slides/Alexander.htm