Researching and Implementing Evidence-Based Management Techniques to Improve Health Outcomes
Statement of Problem
Evidence-Based Medicine (EBM) refers to the conscientious, explicit, and judicious use of current best evidence in making decisions about what types of care individual patients receive. The importance of establishing these evidence-based medical practices, and implementing them into routine patient care, is accepted as an essential element for achieving optimal health outcomes. However, in addition to establishing an evidence-base for what care patients should receive, researching and implementing best practices outlining how that care should be delivered is equally important to maximizing health outcomes. This body or research, called Evidence-Based Management (EBMgmt), strives to apply current best evidence in organizational dynamics, social and behavioral sciences, and systems engineering to operationalize decisions about structures and processes to create a framework in which evidence-based medicine can best be delivered. In other words, to achieve optimal health outcomes, health systems need to expand their focus to include advances in evidence-based management, so that the proper organizational context is in place to support the provision of evidence-based medicine.
Researchers from PolicyLab and The Children’s Hospital of Philadelphia (CHOP) are engaged in several projects related to Evidence-Based Management, including:
- One critical element that affects processes of patient care is the alignment of available frontline clinicians to clinical workload at a given time. Though appropriately matching the workforce to patients’ clinical needs is essential for hospital efficiency, staff satisfaction, and optimizing patient outcomes, many hospitals lack a means to effectively measure and match dynamic workload and workforce factors. To address this issue, a team of researchers developed an objective tool to dynamically match the frontline clinician workforce to clinical workload in a variety of inpatient settings. The tool, which is described in an issue of Journal of Hospital Medicine, is currently used at CHOP to identify gaps in coverage and guide staffing decisions. However, since the tool uses multiple modifiable variables, it can be easily adapted to a variety of other clinical settings.
- Another critical element that affects processes of patient care is the efficiency of patient flow through the hospital. Although patient flow is a focus for improvement in many hospitals, commonly used single measures, such as time spent in the emergency department or percent of discharges completed by a certain time of day, do not capture the full complexity of flow through a hospital. To address this issue, a team of researchers developed a 5-domain patient flow scorecard with composite measurement that considers multiple aspects of patient flow simultaneously. This composite score measurement system, which is described in an issue of Journal of Hospital Medicine, has provided improvement teams and administrators at CHOP with a comprehensive overview of patient flow while also helping to identify operational domains and specific components of patient flow in need of improvement.
- A third set of studies focused on measuring and improving occupancy patterns and reducing overcrowding in emergency departments and inpatient floors. An analysis of patient discharges from 39 freestanding children’s hospitals over a one-year period found that while hospitals frequently experienced periods of high-occupancy, very few implemented acute responses to mitigate the adverse effects of overcrowding on patient care. Thus, a team of researchers examined variability in admissions, discharges, and occupancy patterns, and quantified differences in weekday and weekend occupancy. They found that since scheduled admissions contribute significantly to variability in occupancy and risk of mid-week crowding, while other times often have substantial unused capacity, smoothing occupancy over the course of a week was a useful strategy to reduce crowding. You can read more about this set of studies here, here, and here.
This portfolio of work demonstrates the importance of investing resources in advancing care model innovations and evidence-based management techniques to compliment the growing body of research in evidence-based medicine. While establishing and implementing evidence-based practices in medical treatments is essential, without the proper structures and processes in place to allow providers to deliver that care in the right place, at the right time and in the most effective way, patient outcomes will suffer.
As the famous mathematical physicist and engineer, Lord Kelvin, astutely stated, “If you cannot measure it, you cannot improve it.” Unless more resources and attention are directed towards research in evidence-based management practices, we cannot develop systems for measuring and improving the structures and processes of care that are essential to promoting optimal health outcomes.
The Children's Hospital of Philadelphia, Policy Lab. Researching and Implementing Evidence-Based Management Techniques to Improve Health Outcomes [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].