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).
Slide 1
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).
Slide 2
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.
Slide 3
Speakers
Jeff Alexander, Ph.D
University of Michigan
David Nerenz, Ph.D
Henry Ford Health System
Beth Feldpush, M.P.H
American Hospital Association (AHA)
Slide 4
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.
Slide 5
Discussion
- 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?
Slide 6
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.
Slide 7
Discussion
Question:
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?
Slide 8
Discussion
- 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?
Slide 9
Thank You!
Current as of January 2009
Internet Citation:
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
540 Gaither Road Rockville, MD 20850