1. Increasing the Relevance of Health Care Organizational Research Jeff Alexander, Ph.D. AHRQ Annual Meeting Sept 8, 2008

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. 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.

3. gap exists between this ideal and the current state of the art in evidence-based management gap exists between this ideal and the current state of the art in evidence-based management articles are often inaccessible articles are often inaccessible Focus on research, not practice implications Focus on research, not practice implications ‘popular’ management books and journals confuse the issue ‘popular’ management books and journals confuse the issue Research timeframe makes info obsolete Research timeframe makes info obsolete

4. AHRQ Study What new data/variables should be added to the HCUP data to increase capacity for organization and management research? What new data/variables should be added to the HCUP data to increase capacity for organization and management research? Interviews with hospital and health system leaders Interviews with hospital and health system leaders Interviews with leading researchers Interviews with leading researchers Critical review of the literature Critical review of the literature

5. Findings research evidence is not consistent with the problems and decision-making conditions faced by those who might utilize this evidence. 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. 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.

6. Content Evidence is lacking in a number of areas that are of top priorities to managers Evidence is lacking in a number of areas that are of top priorities to managers safe staffing level and optimal skill mix safe staffing level and optimal skill mix eliminating practice variation eliminating practice variation cost and quality effects of different IT systems cost and quality effects of different IT systems Cost-benefit of medical technology Cost-benefit of medical technology what constitutes effective organizational culture and leadership what constitutes effective organizational culture and leadership

7. Approach Hospital CEOs view cost, quality, and efficiency as inextricably linked Hospital CEOs view cost, quality, and efficiency as inextricably linked Hospital CEOs think about organizational factors systemically, not individually Hospital CEOs think about organizational factors systemically, not individually Hospital CEOs emphasized process related factors rather than structural drivers of cost, quality, and efficiency. Hospital CEOs emphasized process related factors rather than structural drivers of cost, quality, and efficiency.

8. Are We Asking the Right Questions? All organizations are not alike All organizations are not alike Middle ground between individually tailoring approaches and one size fits all formulas Middle ground between individually tailoring approaches and one size fits all formulas Conditional effects of strategies, innovations, or changes Conditional effects of strategies, innovations, or changes

9. Meeting Customer Needs Practice leaders do not consider health services research a part of their information armamentarium 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 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? 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?

10. Opportunities How can systems of accountability be designed to ensure adequate coordination across organizational boundaries and providers of care ? 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? 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 P4P ? What are the organizational and behavior responses to different incentive programs such as P4P ?

11. Opportunities How can organizations promote the diffusion, implementation and sustainability of new, evidence based practices? 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) Are new care models effective in terms of improving quality, and efficient in terms of reducing costs (patient centered medical home)

12. Threats and Barriers Timing Timing Formulating our problems in isolation Formulating our problems in isolation Insufficient interdisciplinary research Insufficient interdisciplinary research traditional structures and incentive systems in universities traditional structures and incentive systems in universities Funding Funding

13. Data Issues Existing data does not address many of the problems managers regard as important Structure not process Structure not process primary data collection primary data collection small sample sizes small sample sizes perceived lack of generalizability of findings perceived lack of generalizability of findings

14. EVIDENCE-BASED PRACTICE EVIDENCE-BASED/ RESEARCH-TESTED/ EFFECTIVE PRACTICES INFORMED HEALTH SERVICES DECISION-MAKING How do we improve capacity of providers to use research to best deliver care to consumers/patients? How do we improve uptake of practices demonstrated to improve consumer/ patient outcomes? INTEGRATION

15. 2 Models that Work Center for Health Management Research Center for Health Management Research Accelerating Change and Transformation in Organizations and Networks (ACTION) Accelerating Change and Transformation in Organizations and Networks (ACTION)