Traversing the Bridge from Health Care Management Practice to Research

Article excerpt

IF THERE IS A BRIDGE from research to practice, I've been crossing against the traffic. In 2000, I moved from the increasingly tough world of health care management practice (thinking I'd done my share and it was someone else's turn) and took up teaching and research (hoping I'd have time to reflect on and leam more about the intractable problems I'd been battling). Unfortunately I failed to consider, even though I "knew", that universities are also operating in an increasingly tough world, and academic work has also been intensified.

But my crossing did coincide with an emerging focus on health services research, which "examines how a variety of factors - from financing systems to medical technologies to personal behaviors - affect health care costs, quality, and access".1 It is a broad field, spanning research on the macro policy settings (how to fund health care, who gets access) through to the micro level of health care practice (for example, how clinicians might work with patients who have chronic conditions as partners in the management of their care).

Often, the meso level (where health care management lives) takes a pretty low profile. It has to be said that every sector of this still very small field, from the health economists to the clinical researchers, would also argue that their areas of interest are neglected. But health care management doesn't really feature in the definition above, and neither does it loom large in the literature emerging from health services research. This may be an obvious point - management of health services is, after all, a means to an end, and should be judged in terms of its effectiveness in supporting the work of clinicians and other health care practitioners. But then, you could say the same about policy. As many a frustrated clinician has reminded me over the years, good policy and good management are prerequisites for good clinical care.

Managers share with clinicians an obligation to ensure that their practice is oriented to achieving the best possible results for patients - a serious undertaking which needs to be based on evidence. We have seen that clinicians have no monopoly on failing to implement evidence. For example, we know that decision making about patient care is more likely to be effective when it is conducted as close as possible to the clinical interaction by practitioners who have adequate skills and who accept authority and accountability. Yet managers have been slow to operationalise this knowledge in organisational structures and processes. Thus the research-to-practice transfer mystery requires attention from managers as much as from clinicians.

So, why aren't the issues of health care management (as distinct from policy) more prominent in health services research? Perhaps one of the problems is that health management is understood to be based on a body of knowledge arising from general management research, and doesn't really need to reinvent the wheel. Again, this is partly true - perhaps we learn too little from general management theory. However, if the attrition rate of general managers brought into the US health system in the 1990s is anything to go by, the general management body of knowledge may be necessary but not sufficient for practising health care managers.

I'd like to explore the potential future development of more and better research about health management through briefly considering the problem of making research relevant to practice, and then advocating for the development of the field known as implementation research.

Can we do industry-led research?

As many who have pondered the challenge of research transfer have pointed out, finding ways to ensure that research is relevant to industry is not a simple proposition (see Brehaut and Juzwishin2 for an overview of some of this work). From the point of view of policy makers and practitioners, research is not a useful method for resolving many of their problems. …