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• Promoting Improvement and Learning through Embedded Research
  Michael I Harrison, Dina K. Moss
  Published on: 5 June 2017

• Published on: 5 June 2017

  Promoting Improvement and Learning through Embedded Research

  • Michael I Harrison, Senior Social Scientist Agency for Healthcare Research and Quality
  • Other Contributors:
    • Dina K. Moss, Senior Social Science Analyst

  Vindrola-Padros and colleagues provide a helpful examination of co-production of quality improvement knowledge by university-based researchers in cooperation with members of service organizations. Another important type of embedded researcher consists of “fully embedded,” researchers, who are academically trained but employed by large care delivery systems. These individuals typically work in research units in the delivery systems. Their work is funded both by the systems themselves and by external, private and public organizations, such as the Agency for Healthcare Research and Quality (AHRQ). These fully embedded researchers contribute actively to national professional forums and journals and sometimes collaborate with embedded researchers in other systems.

  AHRQ leverages relationships with fully embedded researchers because of their deep and nuanced knowledge of internal system data and operations. Health systems-based researchers’ ready access to care sites within which to test new approaches, and to data sources that permit rapid analysis of results of those tests, are of great value to AHRQ as we seek to find solutions to real-world problems in areas of national importance. AHRQ-supported work of this kind demonstrates the value of health delivery organizations becoming “learning health systems”(1) – using their own internal data and resources to drive quality improvement and sharing their findings with other organizations.

  AHRQ’s collaboration w...

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  Vindrola-Padros and colleagues provide a helpful examination of co-production of quality improvement knowledge by university-based researchers in cooperation with members of service organizations. Another important type of embedded researcher consists of “fully embedded,” researchers, who are academically trained but employed by large care delivery systems. These individuals typically work in research units in the delivery systems. Their work is funded both by the systems themselves and by external, private and public organizations, such as the Agency for Healthcare Research and Quality (AHRQ). These fully embedded researchers contribute actively to national professional forums and journals and sometimes collaborate with embedded researchers in other systems.

  AHRQ leverages relationships with fully embedded researchers because of their deep and nuanced knowledge of internal system data and operations. Health systems-based researchers’ ready access to care sites within which to test new approaches, and to data sources that permit rapid analysis of results of those tests, are of great value to AHRQ as we seek to find solutions to real-world problems in areas of national importance. AHRQ-supported work of this kind demonstrates the value of health delivery organizations becoming “learning health systems”(1) – using their own internal data and resources to drive quality improvement and sharing their findings with other organizations.

  AHRQ’s collaboration with researchers in the Palo Alto Medical Foundation (PAMF) Research Institute provides a powerful example of how partnership between fully embedded researchers and external funding agencies contributes to health system learning. AHRQ partnered with Kaiser Permanente and PAMF researchers to study implementation of a Lean-based redesign to improve care delivery efficiency in PAMF’s primary care clinics. (2) Applying Lean analysis techniques, PAMF discovered inefficiencies in a pilot primary care clinic and redesigned work roles and work flow to enhance coordination among physicians and to better support them. Key changes included:
  • New roles for medical assistants as a “flow managers,” facilitating physician’s work and performing administrative tasks like handling email that previously burdened physicians
  • New workflows – including daily huddles for scheduling; agenda setting during patient visits
  • Co-location of physician-medical assistant teams in a shared workspace.
  PAMF then tested these new roles and processes in three additional clinics, assessed the improvements’ effects, and rolled the changes out to 13 additional clinics.

  PAMF researchers interviewed staff to uncover factors influencing successful implementation of these changes and system requirements for successful redesign of care. (3-4) To assess changes in efficiency, they analyzed rich and timely internal data sources such as:
  • Physician efficiency metrics derived from PAMF’s time-stamped EHR data and other operational sources
  • PAMF’s routine patient and personnel surveys
  • Standardized quality metrics that PAMF reports.

  Their research showed that PAMF’s primary care redesigns boosted efficiency without sacrificing quality and satisfaction. (5) AHRQ and PAMF disseminated these valuable findings widely through practice –oriented briefs, conference presentations, and webinars, as well as in peer-reviewed papers.

  PAMF’s fully embedded researchers promoted internal learning by tracking progress and outcomes of the Lean improvement efforts and providing feedback to their system’s leaders and staff. AHRQ and the PAMF researchers promoted system-wide learning about Lean-based primary care redesign by broadly disseminating the study’s findings and implementation lessons.

  References:

  1. Bindman A. You’re invited: join our conversation about learning health systems. AHRQ views, Jan. 12, 2017. [Internet] 2017; http://www.ahrq.gov/news/blog/ahrqviews/join-our-conversation.html (Accessed 5 June, 2017).

  2. Schmittdiel J, Hung D. Executive summary: spreading Lean: taking efficiency interventions in health services delivery to scale. [Internet] 2016; http://www.ahrq.gov/sites/default/files/publications/files/execsumm-lean... (Accessed 5 June, 2017).

  3. Hung D, Gray C, Martinez M, Schmittdiel J, Harrison, MI. Acceptance of Lean redesigns in primary care: a contextual analysis. Health Care Manage Rev 2017; 42:203-212.

  4. Gray C, Harrison MI, Hung D. Medical assistants as flow managers in primary care: challenges and recommendations. J. Healthc Manag 2016; 61:181-191.

  5. Hung D, Harrison MI, Martinez M, Luft H. Scaling Lean in primary care: impacts on system performance. Am J Manag Care 2017; 23(3):161-168.

  Author email: Michael.Harrison@ahrq.hhs.gov

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  Conflict of Interest:
  None declared.

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