Patient Safety and Quality

Hospital CEOs need more research relevant to the challenges they face in the healthcare system

Hospital executives face myriad challenges in providing quality, cost-effective care; however, health services research has not been positioned to provide hospital leaders with evidence to guide their decisions. The challenges the executives face span topics such as managing staffing shortages and productivity; implementing evidence-based medicine and information technology systems; using quality measures and data systems; balancing costs and benefits of medical technology; developing effective leaders; maintaining an effective organizational culture; instituting team-based care; and the changing demographics of patients.

Researchers at the University of Michigan and the Agency for Healthcare Research and Quality (AHRQ) found not just gaps but an abyss between these topics and what has actually been addressed by researchers. The study consisted of interviews with eight hospital and three health system leaders to understand the realities confronting today's hospitals and the capacity of current research to help them meet these needs.

Hospital executives interviewed pointed out, for example, that research has not provided evidence on safe staffing level and optimal skill mix. CEOs of rural hospitals have difficulty locating benchmarks appropriate to their type of facilities. Also, little is known about the impact of different information technology systems on hospital operation and performance.

The authors of this study recommend reshaping research approaches to become more relevant to hospital CEOs with a new focus on those process-related factors that hospital and system executives consider crucial, such as effective communications, strong leadership, and building trust. They also point out that hospital and system executives are seeking evidence of factors that influence cost and quality simultaneously-rather than the studies related to a single outcome that research is producing now. If researchers want executives to consider health care study findings in their decisionmaking, researchers will need to include these executives' inputs and evidence priorities when shaping the research agenda.

See "Increasing the relevance of research to health care managers: Hospital CEO imperatives for improving quality and lowering costs," by Jeffrey A. Alexander, Ph.D., Larry R. Hearld, M.B.A., H. Joanna Jiang, Ph.D., and Irene Fraser, Ph.D., in the April-June 2007 Health Care Management Review 32(2), pp. 150-159.

Reprints (AHRQ Publication No. 07-R077) are available from the AHRQ Publications Clearinghouse.

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