Does Management Affect Healthcare Outcomes Whats the Evidence

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Does Management Affect Healthcare
Outcomes?Whats the Evidence?

• William F. Jessee, MD, FACMPE
• President and CEO
• Medical Group Management Association

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My Thesis

• Management decision-making in healthcare
  organizations, if based on evidence from
  appropriate research or internal data collection,
  can increase the likelihood of positive
  organizational outcomes as measured by financial
  performance, patient/employee/physician
  satisfaction, and clinical results

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Background

• Evidence based medicine
• has had a long, tortuous path to acceptance
• still not universally applied
• but has become the generally accepted mode for
  clinical decision making

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Background

• Evidence based management
• term first proposed by Axelsson in 1998 (Intl. J.
  of Health Planning and Mgt., 13(4) 307-317)
• expanded upon by Kovner et al in 2000 (Frontiers
  of Health Services Management, 16 (4) 3-24)
• the use of empirical evidence in making
  management decisions

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Barriers to Evidence Based Management (from
Kovner)

• Little evidence about best practices and such
  evidence not widely shared
• Healthcare organizations lack size and critical
  mass to conduct and assess applied research

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Barriers to Evidence Based Management (from
Kovner)

• Health systems focus on operating margins and
  past budgets
• Healthcare managers lack training and experience
  in collaborating with researchers and lack
  commitment to applied research
• Nonprofit healthcare organizations lack
  accountability

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Other Barriers

• Too much work
• Threatens leaders (self) image
• Not trendy enough

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So what evidence IS there that management
decision-making affects healthcare outcomes?
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Physician Compensation

• How does physician compensation affect outcomes?
• practice profitability
• patient satisfaction
• patient retention
• patient outcomes

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Productivity Based Compensation Plans
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Percent that Changed Their Physician Compensation
Formula in Past Two Years
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Policies

• How do financial policies in medical groups
  affect profitability?

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Percent with a Written Policy for Insurance
Verification Prior to Service
14
Percent with a Written Policy for Collecting
Copayment at Time of Service
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Management Expertise

• What influence does a board certified practice
  executive have on medical practice profitability?

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Percent of Chief Administrative Officers that are
Members of ACMPE
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Organizational Climate

• How does organizational support for nursing
  affect nurse satisfaction, turnover, and patient
  care?

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• Organizational support for nursing significantly
  more important than staffing levels in
  determining satisfaction
• Burnout reported by 35 of nurses in hospitals
  with high organizational support scores, compared
  with 52 in hospitals with low support

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• Hospitals providing most support for nurses are 3
  times more likely to be rated by nurses as
  providing excellent care than those providing
  least support

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• Hospitals with highest nurse-assessed quality
  have
• 16 fewer deaths (failure to rescue) per 1000
  complications than lowest rated hospitals
• 8 fewer deaths per 1000 admissions

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• All from work of Aiken et al at University of
  Pennsylvania
• See Amer. J. Nursing, 100 (3) 26ff., March 2000
• J. Nursing Adm., 29(2)14-20, 1999

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Do Management Systems Improve Safety and Quality?

• Tracking patient referrals and following up on
  diagnostic studies reduces frequency of delays in
  diagnosis of breast cancer
• Patient tickler files and recall reminders
  reduce complications and hospitalization in
  diabetes, hypertension, other chronic illnesses

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Do Management Systems Improve Safety and Quality?

• Alert systems reduce medication errors,
  allergic reactions
• Waste disposal mechanisms reduce risk of both
  employee and patient infection
• Equipment maintenance reduces risk of
  injury---and increases likelihood of effective
  management of emergencies

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• Are larger medical groups more cost effective as
  a consequence of economies of scale?

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• Economies of scale are maximized in
  multispecialty groups of between 26 and 50
  physicians
• Weil, J. Amb. Care Management, 25(3), 70-77, 2002

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• Does measuring patient satisfaction create any
  return on the investment?

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Percent that Conduct Routine Patient Satisfaction
Surveys
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Some Observations

• There is LOTS of research that could be used to
  drive better management decisions
• More research related to financial performance
  than to clinical performance
• Not always easy to find

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Some Observations

• Management education needs to place the same
  emphasis on evidence-based decisions as does
  clinical education
• Governance needs to demand that managers make
  evidence-based decisions

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A Caveat...

• Healthcare organizations are complex and
  multidimensional
• Most management research isolates one or a few
  variables of interest
• Beware of unintended consequences!

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The Potential Impact

• Increased efficiency and effectiveness
• More rapid dissemination of management
  innovations that work...
• and avoidance of management fads that dont work
• More rational payment policies
• More rational public policies

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• THANK YOU!
• QUESTIONS?