Integrating Research and Practice Health System Leaders Working Toward High-Value Care: Workshop Summary (2015) / Chapter Skim
Currently Skimming:
7 Governance That Accelerates Progress and Sustainability
7 Governance That Accelerates Progress and Sustainability
Pages 85-96
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 85... ...
• One way to send the message that health service delivery re search is important is to give it the same weight as basic science research in an organization's reward system, Rohack said. • "From my standpoint as a leader of an organization," Mary Brainerd said, "I want you to bring your ‘patientness' with you to everything that we do, everything we design, every way we think about what we are going to do in research." • The time frame for most research is too long, and too much knowledge is not put to use in a productive manner, Brainerd added.
|
From page 86... ...
• Steiner said that the governance of interorganizational research "requires us to develop precision tools on the one hand but also to permit the creativity to use those tools in new ways." The culture of leadership and decision making in research networks can be characterized as one of leadership without control. Institutional governance of continuous learning activities that can accelerate progress and sustainability was the focus of a panel of brief presentations by James Rohack, Chief Health Policy Officer for Baylor Scott & White Health, who discussed how his organization aligns research with institutional goals; Mary Brainerd, President and CEO of HealthPartners, who spoke about data sharing in a competitive environment; and John Steiner, Senior Director of the Institute for Health Research at Kaiser P ermanente Colorado, who addressed various issues involved in governing internstitutional research.
|
From page 87... ...
Clearly, he said, there is a business imperative to conduct research related to institutional goals for health care delivery, but governance and related operational mechanisms need to be in place to shorten the cycle time from research evidence generation to related health care organization management decisions. Another lesson was that, although federal funding can be helpful for this type of research, typical federal peer review funding cycle times make it difficult for these sources to play major roles in research related to a health care delivery organization's operational
|
From page 88... ...
"This is an important message," Rohack said. As an example, he briefly discussed a traumatic brain injury research project that connects basic scientists exploring the blood brain barrier with clinical scientists exploring biomarkers for traumatic brain injury, clinicians studying how the symptoms manifest, and quality investigators exploring how data can be used to improve quality of care and quality of life.
|
From page 89... ...
Who controls the indirect dollars from outside grants can be a difficult issue to resolve, he said, particularly in instances where the money flows through the academic center, which takes its cut for overhead and leaves the clinical enterprise to use more of its own funds to support the work; "Trust is the key here," he said. Rohack concluded his remarks by highlighting what he considered an underappreciated crisis, saying that it is important in all of these efforts to remember the incredible pressure that health care providers are under these days.
|
From page 90... ...
One important feature of the latter partnership is that it requires sharing its data publicly and transparently. HealthPartners has also been the sponsor and creator of the Minnesota Community Measurement Community, which delivers performance metrics directly to consumers in Minnesota.
|
From page 91... ...
"I think the opportunities are there to connect in new and different ways with our patients, to remember they come to us with their own knowledge and beliefs." Patient councils can be one avenue for connecting, and Brainerd noted that a patient council that was created to help redesign a physical space for mental illness care not only accomplished that but also ended up catalyzing a new care model for patients with mental illness. She also expressed concern that there is not enough research on the intersection of health care and behavior change.
|
From page 92... ...
Research need to be less expensive, which means relying not only on data collected primarily in the course of large, randomized trials but also on data collected during the course of routine care. Research needs to be more engaged, which means integrating patient and organizational/clinical perspectives as well as the members of interinstitutional research teams.
|
From page 93... ...
"To achieve stable governance of a research network, you need to be able to adapt to different principal investigators, different lead institutions, different scientific priorities, and a whole range of varying pressures and incentives," Steiner said. "Governance structures need to be flexible enough to adapt to the legitimate needs of those projects while also being inclusive enough to gather the learnings from each of these independent scientific networks and studies and to collate them into some organized whole so that you develop common models of analyzing data and the like." The second lesson is that even with substantial infrastructure investments, research networks are unlikely to become independent from institutional support.
|
From page 94... ...
"Are they taking people away from what we want to do, which is to incentivize people's intrinsic motivation to do this kind of research, with mastery, purpose, and autonomy built into it? " Harold Luft of the Palo Alto Medical Foundation asked how governance structures can help increase data transparency among collaborators without putting institutions at risk when data are made public.
|
From page 95... ...
Sometimes, however, it is the workflow itself that needs to be studied, Steinder added, and this is where codesigning interventions with the people who have to carry them out and the people who have to live with the consequences is of critical importance. Susan Huang noted that in the REDUCE MRSA trial, every thread of every protocol that was developed considered whether a particular action would be feasible in common practice.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.