Enhancing Organizational Research in Health Care Quality

AHRQ 2008 Annual Conference

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!