Evidence-based Management in healthcare

Research to inform management practices to optimize both workforce wellbeing and organizational mission

News:
Twitter: In order to reduce burnout in medical personnel, burnout must be broadly measured.
A new Systematic Review from @KUSM_Wichita authors shows important obstacles to accurate measurement. (https://buff.ly/3VdBzSU).

Four Assertions

1. Creating workforce psychological engagement and achieving organizational performance are not a zero-sum scenario, but can be synergistic.
Engagement:
  • Defined as Vigor (physical engagement), Dedication (effective engagement), Absorption (cognitive engagement). Schaufeli, 2006
  • Measured by: UWES 3 and other scales
  • Antecedents: Self-determination theory (SDT) (Ryan & Deci) and Engagement framework(Kahn, 1990)
    		•  What we have found:
    1. Badgett et al. Hospital Workforce Engagement and Inpatient Mortality Rate: Findings from the English National Health Service Staff Surveys. J Gen Intern Med. 2020 PMID: 33051836
    2. Creating workforce engagement is necessary...
    ...but not sufficient to improve organizational performance.     		What we have found:
    1. Boyle RE et al. Hospital workforce engagement, satisfaction, burnout and effects on patient mortality. Health Serv Manage Res. 2023 PMID: 37230804
    2. Bharwad et al. Can clinical sites achieve both workforce well-being and organizational outcomes together? Kansas Chapter 2023 Annual Scientific Meeting & Hospitalist Day. October 6, 2023. Wichita, KS
    3. Management is hard, with competing demands and requiring diverse skills , and it should be monitored yearly to guide a) bright-spotting & hot-spotting, and b) support managers, and c) identification of potential leaders/managers for advancement (1). What we have found:
    1. Does Glassdoor data suggest benefit in serial measurement of workforce experience?
    4. Bright-spotting and hot-spotting as implemented by positive deviance can be used for all areas of mission improvement including management (1), teaching (2), and clinical care (Sealy et al), and most importantly, 3) management and leadership (Management measurement). What we have found:
    1. Does Glassdoor data suggest benefit in serial measurement of workforce experience?
    2. a. Brumfield et al. Using Positive Deviance in Medical Education to Empower Learning. 2020 Association of American Medical Colleges 2020 IQ meeting.
      b. Jahansooz et al. Using Positive Deviance (PD) in Medical Education to ​Empower Teaching: Is PD appropriate?​ KUMC Faculty Research Day. 2020
    3. Wilson et al. Are there positive deviant nurses in the speed of administering antibiotics for sepsis? American Academy of Emergency Medicine (AAEM) Baltimore, MD 04/2022

    Additional implications

    1. Measurement of burnout is not well standardized which hinders benchmarking when using copyleft survey items (1).
    2. We need to revise management development as current leader education may focus on advancing the manager more than advancing the organization (Straus et al, 2).
    3. QI methods, like management methods in general, should be revised as its current basis on outdated modes of management may reduce engagement and contribute to burnout (3)
    4. While teaching and disseminating new management tactics is needed, “leadership-light” tactics can be taught to all of the workforce (4).
    		 What we have found:
      <1--
    1. Hagan et al. Correlations between measures of workforce burnout. 2022 Annual Meeting of the Society of General Internal Medicine; 2022 April; Orlando, FL. J Gen Internal Med 2022;37:s252: Society of General Internal Medicine; c2022
      2. -->
    2. Hagan G, Okut H, Badgett RG. A Systematic Review of the Single-Item Burnout Question: Its Reliability Depends on Your Purpose. J Gen Intern Med. 2024 Apr;39(5):818-828. Epub 2024 Feb 29. PMID: 38424346
    3. Brumfield et al. What leadership tactics foster innovation: a journey into the evidence-practice gap in business research. 2019 Annual Meeting of the Society of General Internal Medicine; 2019
    4. Duran? et al.Does Participation in QI Affect Clinician Burnout?
    5. Emberson et al. A summary meta-narrative of positive deviance and similar studies that gives a narrative, qualitative description that contrasts individual clinicians or clinical sites who are positive deviants in a process or outcome measure (leadership light). (in process)
    What we have created:
    1. Survey compendium focusing on surveys that provide benchmarks and copyleft access.
    2. Analyis of heterogeneity and and identification of deviancy online software
    3. Goal setting and benchmarking online software. Hawley et al. Setting quality improvement goals to great success in patient clinics. Kansas Public Health Association Annual Conference; 2022 September 30; Wichita, KS. Kansas Public Health Association.

    Our studies

    Bison at Kansas's Tallgrass Prairie Preserve
    Hiking and bison at Tallgrass Prairie Preserve, KS

    Bibliography of background studies (Zotero)

    Rocktown at Wilson Lake
    Snow at Rocktown Trail, Wilson Lake, KS

    This project is maintained by ebmgt.github.io/