Health

Evidence-Based Management is the Road Less Traveled, Says Prof. Anthony Kovner

Evidence-Based Management is the Road Less Traveled, Says Prof. Anthony Kovner

[Anthony Kovner]

When organizations or businesses stumble, the search for an explanation often leads back to the quality of the evidence-gathering process. It is that process, known as Evidence-based Management (EBM), that fascinates Anthony R. Kovner, who has spent more than a decade trying to get managers to employ it when they seek ways to improve their organization’s performance and results.

Professor Kovner teaches EBM to students at the Robert F. Wagner Graduate School of Public Service, where he is a professor of public and health management and the director of the Executive MPA Program for Nurse Leaders. He is also the author of several books on healthcare management. Shortly before the publication of a chapter he recently wrote, entitled “Adventures in the Evidence-based Management Trade,” for the forthcoming Oxford Handbook of Evidence-Based Management (Oxford University Press), he sat down with NYU Research Digest (Spring 2012)  to discuss Evidence-based Management.

What’s the theory behind EBM?

Evidence-based Management comes out of medicine—the idea that if you make a medical intervention, it should have a predictable and positive outcome. We said, “Why can’t we apply this in management?” Well, the truth is, it’s not a simple matter. We know a lot less about management than medicine, for which there’s a huge medical research establishment, the randomized clinical trial, and an established process for scientific review.

What professional sector does EBM most lend itself to?

To every sector. So for example, when two large health organizations decide to merge, we say, “Wouldn’t it make sense to look at the best available evidence before making a decision to merge?” Instead, a very common managerial response is: “We want to merge—let’s find the evidence that justifies it.” So these managers need to do more than just type “hospital merger” in Google? Keep in mind that all managers make decisions based on evidence. The point is, what is the quality of the evidence? It can be pretty shabby.

What’s wrong with the process as it works now?

When, for instance, two large institutions decide to merge, to what extent do they ask in advance, “What do we know about successful and unsuccessful mergers?” Generally speaking, what they do is ask the consultants, and the consultants say, “This would work in Akron.” But of course that doesn’t mean that it would work in Brooklyn. Are the merging institutions’ two geographies compatible? What about their respective cultures? It’s not that you get to a solution—these kinds of problems are too messy, too wicked, and the causation is not as clear as in randomized clinical trials. But it informs your thinking so you can see and avoid the worst consequences of what might happen.

How should the evidence gathering begin?

Three basic steps: search and locate the best available evidence, learn from best practices, and try doing your own management research. If you are studying why nurses turn over so much in your hospital, it’s important for you to understand the differences between the 12-hour day shift and the 12-hour night shift. The most important step, though, is to ask the right question, and translate your management challenge into an answerable one.

If EBM is so effective, why don’t more organizations engage in it?

That’s the $64,000 question, and it’s not an easy question to deal with. What it really is about is power and hierarchy and organizations. Let’s say an employee comes up with a better way of doing something and tells the boss about it. You’d expect the boss to say it’s a great idea, let’s do it. But in practice the boss says, “You’re insulting the way I’m managing this place,” or “If you thought of it, then how good can it be, if I didn’t think of it,” or “Go ahead and present your ideas to the higher-ups, and if they like it I’ll take credit for it, and, if they don’t we’ll blame you. “

That sounds almost insurmountable.

The trick of it is to make the politics work for you. To get it implemented, you have to get the managers to see that it’s in their political interest to practice evidence-based management. And I believe it is.”

Featured Case Study: Ellen Schall and the Department of Juvenile Justice

Featured Case Study: Ellen Schall and the Department of Juvenile Justice

When Dean Ellen Schall was appointed commissioner of New York City’s Department of Juvenile Justice, she transformed the troubled agency into one that Harvard University and the Ford Foundation selected to win their prestigious Innovations Award. This iconic case study is featured on Electronic Hallway at the University of Washington Evans School of Public Affairs

Finkler Receives Top AACN Award

Finkler Receives Top AACN Award

Professor Steven Finkler, Director of the Wagner School Specialization in Public Finance and Financial Management, has been awarded the 2002 Pioneering Spirit Award by the American Association of Critical Care Nurses.

From The Examining Room to The Chat Room – Is Information Technology the Prescription for Better Healthcare?

From The Examining Room to The Chat Room – Is Information Technology the Prescription for Better Healthcare?

JANUARY, 2002

The January Wagner-Commonwealth Health Dialogue titled “From Examining Room to Chat Room: Is Information Technology the Prescription for Better Health Care?" examined the growing use of information technology in health care across a spectrum from hospital-based clinical and administrative information systems to the provider-patient relationship, and the consumer use of the internet for health information.

The dialogue brought together some of the top experts in these areas:

Ann C. Sullivan, Senior Vice President and Chief Information Officer of Maimonides Medical Center in Brooklyn, which was named one of the most Influential IT Organizations in the United States by Advance Executives; Thomas Delbanco, M.D., Chief of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center; Mary Jo Deering, Deputy Director for Management and e-Health in the U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion; and Dr. George Anderson, MD who has had a 30-year career in health care information technology and who has served as President and Chief Executive Officer of Oceania, Inc., which developed software solutions for physicians and other healthcare providers.

Sullivan said Maimonides’ IT system, Eclipsys, is used by all parties in the hospital and has brought extraordinary efficiencies. They have seen a 68% decrease in medication processing time; 60% decrease in medication discrepancies; 20% overall decrease in duplication of ancillary orders; and 48% decrease in laboratory tests. These savings contributed to a 12.4% decrease in length of average stay and 8.7% decrease in re-admissions, and generated nearly $20 million in increased admissions. They also led to much better information at the point of care, better regulatory compliance and increased patient satisfaction.

While acknowledging that real progress has been made, Dr. Anderson challenged the notion that health care was in the middle of a “technological revolution.” “Off the shelf” solutions to health care IT needs are usually not available, medical software development is expensive and medical applications using products created for other purposes often do not work. “Yes, we are experiencing real change” he said. “But the transformation is slow and far from complete.”

Dr. Delbanco framed his analysis of IT usefulness in terms of how it helps in the doctor-patient relationship. He said IT has given doctors and patients the ability to easily “convene around a shared patient record.” This, combined with a streamlining of information flow to clinicians, administrators and clerks, helps keep the patient fully informed. He regrets that IT has brought about a loss of privacy of the medical record, but said that at this point, ‘there’s no going back.”

According to Dr. Deering, a Pew Internet and American Life Project survey found that 70% of those who search for health information on the internet said that information influenced their decision about treatment; 50% said it led them to ask a doctor new questions or get a second opinion; and 28% said it affected their decision about whether or not to visit a doctor.

The National Committee on Vital and Health Statistics has been pushing for the development of a National Health Information Infrastructure (NHII) in order to capitalize more fully on dramatic transformations in information and communication technologies to improve health on a national and global scale. Dr. Deering said the NHII should be a set of technologies, standards, applications, systems, values, and laws that support all facets of individual health, health care, and public health, and that connects distributed health information in the framework of a secure network with strict confidentiality protections. But, she said, to implement the NHII, strong federal leadership, increased health-related IT funding and laws that protect privacy and make health data gathering easier are needed.

Funded by a generous grant from The Commonwealth Fund, the Wagner-Commonwealth Dialogue Series creates opportunities to facilitate the timely translation of health services research findings –even work in progress –from the researcher to practitioner, policymaker and the informed public.

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