Organizational Research with Impact: Working Backwards

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Abstract
BACKGROUND OR RATIONALE: To improve health care, we need to improve the organization of care, along with the payment systems that shape organizational priorities and behavior. The opportunity and challenge for research are to find a way to work with health care leadership so that future management decisions can make use of strong evidence. This article uses findings from research on nursing to illustrate the potential for organizational research and management research to improve health care. It then distills recommendations from six focused stakeholder meetings to identify five ways in which we might improve organizational, management, and policy research to maximize its use. Hospital, health plan, and other system leaders have five recommendations for research: (1) Design studies that answer user questions, with a focus on the "why" and "what if" rather than just the "what." (2) Present findings in leaders' time and space, defining evidence as they do and identifying generalizability of findings. (3) Change the incentive system for researchers so that they are rewarded for the activities that maximize impact on decision making. (4) Build user-researcher collaborations and dialogue. (5) Change the way we disseminate evidence, with dissemination through "early adopters," trade association meetings, consultants, etc. System and policy leaders control important levers for improving health care, since they shape organizational structure, processes and culture, payment strategies, program design, and regulation. Just as evidence-based medicine can improve clinical practice, evidence-based management and policymaking can change how these powerful levers are used. But for evidence to inform the decisions of system and policy leaders, we will need to rethink and restructure the research enterprise itself, bringing the potential users of evidence into the production process.