Transforming health care through research and education.
Leveraging research and education to create a society of healthy communities, where all individuals reach their highest potential for health.
Anthony R. Kovner, PhD, New York University
Favorable external conditions, a questioning culture, an accountability structure, and participation in management research all encourage health system managers to use research-based evidence to improve their health systems’ performance.
As part of a project examining health-care managers’ use of research-based evidence to make decisions for improving their health systems’ performance, more than 75 managers and other experts were interviewed. Questions centered on four practical topics that are frequent subjects of research projects:
Overall, researchers found that favorable external conditions, a questioning culture, an accountability structure, and participation in management research were important factors in the effective transfer of new research evidence to managers and its subsequent evaluation and application within their health systems.
Favorable external conditions for knowledge transfer include factors that affect an organization's ability and willingness to acquire, assess, adapt and apply evidence. Those surveyed said that their health systems placed a high value on evidence-based managerial decision-making. However, their search for evidence was limited by time pressures, competing priorities, and difficulty in obtaining relevant evidence and adapting it for use. External organizations increasingly provided benchmarks and set performance targets, but "pay for performance" generally lacked scientific underpinning.
A questioning culture encourages questioning behavior among managers, which impacts the amount and speed of knowledge transfer between producers, disseminators and targets of evidence-based management. Interviewees noted that evidence-based management was increasingly valued by their organizations, but their comments also indicated a lack of formal guidelines for obtaining and assessing evidence. Rather than obtaining evidence directly from researchers or research journals, managers said they obtained information from websites, trade journals, consultants, peer groups, professional meetings, and networking with colleagues, especially those in their health system.
Formalizing an accountability structure for the dissemination and use of evidence enhances knowledge transfer and its application within a health system. However, research interviews revealed that health systems did not generally designate managers as being responsible or accountable for knowledge transfer or management. Few metrics were in place for assessing the benefits of obtaining better evidence for management decision-making.
The level of participation in management research directly affects the dissemination, use, and impact of research within a health system. For optimum results, managers and researchers must work cooperatively to define a research agenda; research is framed in the context of application; and the research is interdisciplinary. Interviewers found that most managers conducted their own studies, focus groups and market assessments and that most health systems lacked specialists in knowledge management.
Kovner recommends nine practical strategies for health systems seeking to encourage evidence-based management:
Kovner’s research also yielded insight on the four specific research topics addressed during interviews with managers and other experts.
A barrier to improving diabetes management is the organization of services primarily for acute (rather than chronic) care. This is largely due to financial reimbursement for care.
Budgeting and Strategic Priorities
One research priority that emerged as a result of the interviews was the need to study the benefit/cost of the budgeting process with the objective of reducing the time managers spend on the process.
Each health systems had an organizational dashboard, but managers reported little reflection on: priorities among the indicators, the processes by which the indicators were set and changed, or the targets or benchmarks chosen.
Compensating Managers Responsible for Physician Performance
Given the importance of the topic, researchers were surprised by the lack of experimentation reported in this area when compared to health systems’ experimentation with compensating physicians for performance.
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