Enhancing Organizational Research in Health Care Quality

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Enhancing Organizational Research in Health Care
Quality

• SpeakersJeff Alexander, PhD, University of
  Michigan David Nerenz, PhD, Henry Ford Health
  SystemBeth Feldpush, MPH, American Hospital
  Association

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What is this about?

• The 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.

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Speakers

• Jeff Alexander, Ph.D.
• University of Michigan David Nerenz, Ph.D.
  Henry Ford Health SystemBeth Feldpush, M.P.H.
  American Hospital Association

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We can we do to go from here to there?
A Golden Bridge?
A Broken and Abandoned Bridge?
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Discussion

• Jeff AlexanderNot 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?

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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 Clinics 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 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.

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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?

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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?

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Thank You!