Increasing the Relevance of Health Care Organizational Research

Slide Presentation from the AHRQ 2008 Annual Conference

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On September 8, 2008, Jeff Alexander, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (130 KB).

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Slide 1

Increasing the Relevance of Health Care Organizational Research

Jeff Alexander, Ph.D.
AHRQ Annual Meeting
Sept 8, 2008

Slide 2

The Problem

• 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.

Slide 3

• 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.

Slide 4

AHRQ Study

• 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.

Slide 5

Findings

• 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.

Slide 6

Content

• 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.

Slide 7

Approach

• 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.

Slide 8

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.

Slide 9

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?

Slide 10

Opportunities

• 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)?

Slide 11

Opportunities

• 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)?

Slide 12

Threats and Barriers

• Timing.
• Formulating our problems in isolation.
• Insufficient interdisciplinary research.
• Traditional structures and incentive systems in universities.
• Funding.

Slide 13

Data Issues

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.

Slide 14

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.

Slide 15

2 Models that Work

• Center for Health Management Research.
• Accelerating Change and Transformation in Organizations and Networks (ACTION).

Current as of January 2009

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Internet Citation:

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

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