Summarize the Process Summarize the evidence based step-wise process outlined in the reading. Based on the readings, is it unrealistic to expect managers to adopt this systematic approach? Explain. Include at least two APA-formatted citation (in-text, as well as the full reference). The citation may be from course textbooks, assigned readings, or an outside source. Your initial post must be a minimum of 300 words in length. INTRODUCTION: ON THE PRACTICE OF EVIDENCE-BASED MANAGEMENT Anthony R. Kovner Richard D’Aquila David J. Fine Evidence-based practice is a paradigm for making decisions that integrate the best available research evidence with decision maker expertise and client/customer preferences to guide practice toward more desirable results (Rousseau 2006). Our Intent We wrote this book to share the experiences we and others have had in reflecting on and practicing evidence-based management (EB management). The book can serve as a text for a capstone course emphasizing EB management and as an invitation to healthcare organizations to practice EB management. We also hope to encourage healthcare organizations to fund EB management research initiatives. We assume that those who manage and those who teach management and do management research have a lot to learn from each other. We have not written this book as an academic exercise. Nor have we merely presented practitioner war stories. The ten case studies in this book were written by managers and researchers involved in management interventions using some approximation of the evidence-based approach, sometimes retrospectively superimposing the EB management framework on already existing initiatives. We believe discussion and analysis of these cases will encourage those who study and practice healthcare management to obtain higher-quality evidence on management issues and to use it more effectively. The benefits of using an EB management approach—especially the longer-term benefits—often far outweigh the costs. You will read about some of these benefits in the case studies. Bad decisions, which can cost hundreds of thousands of dollars, may be avoided by spending the extra time and usually minimal financial resources on the EB management process. A Scenario Imagine the situation confronting the CEO of a 1,450-bed, 40-year-old urban hospital that is operating at full capacity and has a 10 percent market share in its region of 2 million people. The CEO must decide whether to recommend to the trustees that the main facility be rebuilt, and if so, whether to build satellite facilities and where they should be located. These decisions are complicated and costly, with many consequences, and different managers would approach them in different ways. Alfred’s approach: CEO Alfred hires three sets of consultants to bid on a planning project, reads several business books on strategic planning, and attends one or two professional meetings with sessions on this topic. Alfred discusses strategic planning with members of his board and the medical staff, management colleagues, CEOs of other hospitals, the president of the state hospital association, and major insurers. The information Alfred obtains from these sources does not always jibe, although all advisers agree that to stay competitive, Alfred has to rebuild his main facility at some time in the near future. Barbara’s approach: In the same situation, a second CEO, Barbara, considers acquiring a neighborhood community hospital that is operating at 60 percent capacity, losing substantial money, and providing uneven quality of care. Her strategy is to serve lowacuity hospital patients there, instead of at the main facility. State regulators are urging her to take over the community hospital. If the hospital goes under, this takeover will worsen healthcare access problems for its underserved neighborhood. The regulators have suggested financing the takeover with state payback to hospital bondholders, and then raising the county hospital’s reimbursement rates by 30 percent to equal those of the main hospital. Chuck’s approach: A third CEO, Chuck, reviews management research and websites on strategic planning and mergers in hospitals and health systems, visits best-practicing health systems, and talks with consultants and managers. Chuck seeks evidence on the changing demographics of different actual and potential markets for his hospital and on the competitive strengths and weaknesses of key hospital competitors. He also seeks evidence on the amount of financing required under different merger/alliance options, ways this money can be raised, and the share amount that must be raised from the main hospital’s operations. All three CEOs use evidence to choose and implement managerial interventions. The use of one approach does not preclude the use of another. Two approaches, or parts of all three approaches, can be used together. The approaches vary in terms of costs and benefits. This book hypothesizes that carrying out a process of evidence-based decision making, which may include all or only some of the activities referred to above, will lead to more informed decision making and better organizational results. All management decisions are based on evidence of varying quality. Too often in this fast-moving field, decision makers rely primarily on what has worked before or on a superficial analysis. We are not suggesting that there is valid and reliable evidence that can be inexpensively obtained for every planned managerial intervention. At times there may be significant costs to obtaining the necessary evidence, and these costs may not always be justified. The real and measurable costs of EB management must be weighed against potential significant benefits over the longer term that may be hard to quantify or to attribute to the specific EB management intervention. Nevertheless, the process of EB management is often valuable in itself, as it can focus management thinking. For example, managers might be cautious about merging with hospitals across town if mergers between adjacent hospitals are shown to be more likely to succeed. Deeper analysis may (or may not) reveal that the successes occurred because of physicians’ greater willingness to change hospital affiliations to a nearby facility and patients’ greater willingness to travel there for specialty services. Research may also show which services and marketing strategies contribute to a successful merger regardless of location. Without that depth of understanding, the decision is essentially a coin toss. The following evidence-based, step-wise process is the core of EB management: (1) framing the question; (2) acquiring research information; (3) assessing the validity, quality, applicability, and actionability of the evidence; (4) presenting the evidence to those who must act on it; (5) applying the evidence to the decision; and (6) evaluating results. These steps are often described in slightly different ways, covering the same activities, or, as noted, combined as appropriate. We are not rigidly prescriptive with respect to an EB management methodology, however, and believe that a systematic approach is essential, regardless of the steps used to apply it. Our Approach to Case Studies This book presents ten case studies examining management interventions. They were written by researchers who are experienced case writers and by managers who have lived through the experiences they describe. We encouraged the case writers to present the perspectives of stakeholders who argued for other alternatives and/or had differing perceptions as to the costs and benefits of the proposed management interventions. We also encouraged them to be brief regarding the success or failure of the interventions. We were primarily interested in how and why managers made decisions regarding planned interventions. In many instances, these fresh case studies have not yet fully played out. Audiences The primary audiences for this book are students of healthcare management, teachers, researchers, and healthcare managers. For example, one of us (Kovner) uses EB management as a primary pedagogical method for a capstone course, in which teams of three to five graduate students develop management interventions for a client organization. The book can also be used in tandem with standard texts in healthcare management, such as those written by Griffith and White (2007), Shortell and Kaluzny (2000), and Kovner and Neuhauser (2004). Plan of the Book This book comprises five parts: Part I. Transformation to Evidence-Based Management This part begins with research findings from Rundall and colleagues regarding the reasons why managers do not use EB management more widely in healthcare organizations. Hospitals and other healthcare organizations in the United States can be said to be operating in a time warp; some are operating as if it were 1950, or 1975, or 2000, or 2025. D’Aquila, Fine, and Kovner present their own experiences in moving toward practicing EB management in their disparate institutions. Respectively, these institutions are Yale-New Haven Hospital (New Haven, Connecticut), St. Luke’s Episcopal Health System (Houston, Texas), and Montefiore Medical Center (Bronx, New York) and Lutheran Medical Center (Brooklyn, New York). Rick D’Aquila describes the culture of Yale-New Haven Hospital, where he has led several important management initiatives as chief operating officer, including strategic planning, resource allocation, quality and safety surveillance, and development of performance management and operational dashboard systems. David Fine describes efforts over three years to transform the management culture at St. Luke’s, where he is CEO. Tony Kovner then shares his experience with how management decisions are made at Montefiore Medical Center, where he has served for 16 years as a management consultant—primarily helping physicians perform management jobs more effectively—and at Lutheran Medical Center, where he has served as a member of the governing board, also for 16 years. Kovner focuses on the gap between EB management in theory and in practice. Part II. Theories and Definitions of Evidence-Based Management This section examines the way EB management is being defined and applied, specifically reviewing: •Various theories and definitions of EB management, the types of questions to which EB management can be applied, and the valuable research of Hsu and colleagues (2006) regarding implementation; •The use of evidence-based decision making by physicians and nurses that has resulted in patient-care guidelines and related decision-support materials; and •The use of EB management in business organizations, including healthcare organizations in Canada and the United Kingdom. Kovner and Rundall group the types of management issues to which EB management can be applied into three areas: core business transactions, operational management, and strategic management. The types of questions it can answer range from: “What methods for paying physician claims achieve speed, convenience, and accuracy requirements?” to “How can nurse absenteeism be reduced?” to “How do hospital mergers affect administrative costs?” This section also reports on recent research to identify and explore factors associated with knowledge transfer between researchers and managers of health systems (Kovner 2005). The research focused on managers of five health systems and four types of decisions: selecting the indicators for success of diabetes management programs; strengthening the relationship between budgeting procedures and strategic priorities; selecting the operational metrics in managerial dashboards; and adapting compensation systems for managers of physician performance. Hsu and colleagues conducted four discussion groups with senior managers and policymakers from public and private healthcare organizations, from which they developed a set of tools to help decision makers obtain and assess information for use in making decisions about potential management interventions. The Management Toolbox that resulted, an excerpt of which is abstracted here, describes the six steps in the EB management process. Sara Mody has written a reference for students on how to search for evidence in the literature, using “improving governance in nonprofit hospitals” as an example. Part III. Case Studies of Management Interventions Using an Evidence-Based Management Approach The case studies describe the use of the evidence-based approach in managerial inventions, undertaken on a variety of topics and in a variety of institutional settings. The range of topics and diversity of institutions involved have been crafted to demonstrate the wide applicability of the EB management approach to problem solving. Part IV. Lessons Learned, and Where Do We Go from Here? We draw conclusions from the lessons learned in our own attempts to encourage EB management. We address how incentives in these organizations can be aligned with EB management priorities and how culture that strongly supports evidence-based medicine can be leveraged to favor the implementation of evidence-based management, too. The authors discuss their plans to spread EB management utilization in their own organizations. (Figure 1 shows where organizations should focus their efforts.) FIGURE 1: Evidence-Based Decision Making: Where to Focus for Improvement SOURCE: Reprinted with permission of the Canadian Health Services Research Foundation. Part V. Appendix Sara Mody has written an appendix on selected sources of information on the evidence-based approach and related topics. Instructor Resources Instructor resources for this book are available online. Materials include instructor’s notes on statistics, financial analysis, and management; curriculum content; a syllabus for a capstone course; additional reading materials; and links to various websites. For instructions on how to access this information, e-mail hap1@ache.org. References Griffith, J., and K. White. 2007. The Well-Managed Healthcare Organization, 6th edition. Chicago: Health Administration Press. Hsu, J., L. Arroyo, I. Graetz, E. Neuwirth, J. Schmittdiel, T. G. Rundall, and M. Gibson. 2006. Methods for Developing Actionable Evidence for Consumers of Health Services Research (Match Study): A Report from Organizational Decision-Maker Discussion Groups & A Toolbox for Making Informed Decisions, #290-00-0015. Rockville, MD: U.S. Agency for Healthcare Research and Quality. Kovner, A. R. 2005. “Factors Associated with Use of Management Research by Health Systems.” Unpublished report for the Center for Health Management Research. Seattle: University of Washington. Kovner, A. R., and D. Neuhauser. 2004. Health Services Management: Readings, Cases and Commentary, 8th edition. Chicago: Health Administration Press. Rousseau, D. M. 2006. “Is There Such a Thing as ‘Evidence-Based Management’?” Academy of Management Review 31: 256– 69. Shortell, S., and A. Kaluzny. 2000. Healthcare Management: Organizational Design and Behavior, 4th edition. New York: Delmar Publishers, Inc. (PhD xv-xxvii) PhD, Anthony R. K., David J. Fine, FACHE, and Richard FACHE. Evidence-Based Management In Healthcare. Health Administration Press, 2009. VitalBook file. 
Purchase answer to see full attachment