What Greater Role Can Evidence-Based Management Play in Healthcare?


I’m Tony Kovner, a Professor of Healthcare
Management at the Wagner School. I’ve been involved for the last ten years studying
something called evidence-based management And, it’s a concept that came from
medicine — evidence-based medicine — where the idea was that any medical intervention
should have a positive, predictable impact on somebody’s health. So, we took these parameters,
tried to take this concept, into the world of management. The only problem or
issues: we know a lot less about management than we know about medicine.
And, it’s been estimated we know about five percent, where you can predict that an intervention will have a positive predictable impact. My experience comes from
three sources; it’s all in healthcare. First of all, I was a hospital CEO. So, I have that experience. Second of all, I was a board member
for twenty-five years of a large Academic Medical Center, which revealed this experience. And, third of all, I was a consultant to a different Academic Medical center for twenty-five years. My approach to
teaching management at the Wagner school has been to ask the right question, get the data,
present the data to your boss, the manager, and then let him decide what this means. And, hopefully, you’ve read the data in such a way that he’ll say, “This is what I think we ought to do,” and then you’ll be able to say “Gee, boss. That’s a great idea. Let’s do it”; and you have the buy, and you can move
forward. One year, we got this project: How do we get nurses to spend more time with
patients and less time on supplies, and hunting down supplies, and traveling
in the unit to get supplies? We had five nurses and they worked on this for a year, a
day a week. They reviewed the literature and they reviewed best practice and they made observations
and they came up with recommendations, and the client was delighted with the recommendations and said they planned to implement it. This process affects management — and, I think, policy across schools — and, in fact, it’s a movement that started medicine that has expanded to nursing, criminal justice… The same process can be used
in many different sectors. The impact that I that I hope to have is to
actually implement this approach with real hospitals and real managers; and then
to document how it works; and to improve on the process; and to explain why it
works, and explain to what extent it works. It’s fascinating to me to figure out what works and
what doesn’t work, and in order- Really, along the mission of the school, which is public
service, we spend two trillion dollars on healthcare every year, and
we don’t get that good results in health compared to other countries. And,
we’ve got to take some of the waste out of the system — people have estimated it to be
thirty or forty percent of the dollars that are spent — and, I’m really excited to be working with others to make progress on a variety of fronts, to come up with better decisions.

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