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 (515 KB; Plugin Software Help).
Enhancing Organizational Research in Health Care Quality
Jeff Alexander, PhD, University of Michigan.
David Nerenz, PhD, Henry Ford Health System.
Beth Feldpush, MPH, American Hospital Association (AHA).
What is this about?
- The Institute of Medicine (IOM) report "Crossing the Chasm" (2001) calls for improving healthcare organizations in order to improve quality of care.
- But there seems to be a "chasm" between researchers and healthcare executives.
- This session features presentations and discussion on what the key issues are and what we can do to bridge the gaps.
Jeff Alexander, Ph.D
University of Michigan
David Nerenz, Ph.D
Henry Ford Health System
Beth Feldpush, M.P.H
American Hospital Association (AHA)
We can we do to go from here to there?
The slide shows two photographs: a black and white photograph of a broken and abandoned bridge with an arrow pointing to a colored photograph of a golden bridge.
- Jeff Alexander:
Not all organizations are alike, therefore need "middle ground between individually tailoring approaches and one size fits all formulas."
- Question—What is that middle ground?
- David Nerenz:
- Researchers are concerned about cause-effect relationship that can be generalizable.
- Managers look for implementable solutions to their daily problems or directions for their organization. And they have to fit the local context of individual organizations.
- Question—How can these two be reconciled?
Building the Bridge to the Other Side—A Different Research Paradigm (David Nerenz)
- Clinician researchers—those who actually do patient care should be those who design, test, and refine health care delivery innovations.
- Research in clinic and inpatient unit "laboratories"—example—Mayo Clinic's SPARC unit. Research done in organizations, not about organizations.
- Research on truly new things to determine whether they can work, rather than on big, already-implemented things to determine whether they do work (or did work!).
- Focus on managers' problems rather than policy-makers' problems—e.g., reducing medical errors, reducing no-shows, enhancing interpreter services, reducing inefficiency and duplication... (industrial engineering)
- Small, bite-size problems rather than large, mega-problems (not, "Do EMRs [Electronic Medical Records] enhance quality of care?", but 100 specific questions on how to create or enhance an effect of a specific EMR system on quality of care)
- Explicit study attention paid to local context effects and interactions rather than use of randomization designs and regression models to eliminate them.
Does the paradigm proposed by David sound a bit too pessimistic?
Would it seem to reduce research into OR (Operational Research) type of studies or narrow our efforts to just doing small-scaled demonstration projects?
- AHA seems to have assumed a role of middleman in bridging the gap between researchers and managers—dig out research evidence, synthesize them, and translate into practical how-to-guide.
- Question—Who else should or can take this role as well?
- The AHA hospital survey so far represents the largest hospital sample. But the focus is primarily on hospital structural characteristics, services, utilization, and financial information.
- Question—How likely for AHA to develop other surveys to look at process, or leadership and culture?
Current as of January 2009
Enhancing Organizational Research in Health Care Quality. 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/Alexander2.htm