Quality Improvement

Understanding Management in Healthcare

By K. John McConnell, PhD

In the search for tools to build a high performing health system, many observers have pointed to the potential role for modern management practices, including the approaches of Lean management developed at Toyota and famously adopted by hospitals like Virginia Mason in Seattle. Atul Gawande has suggested that management tools used in The Cheesecake Factory could be beneficial in hospital settings, and recent results from the Center for Medicare & Medicaid Innovation’s Pioneer Accountable Care Organization (ACO) Model revealed that the top performing ACO was closely associated with ThedaCare, an integrated health care system with a nationally recognized management system.

Better management may be the key to a better health system. But, what do we mean by “management”? Our article “An Exploration of Management Practices in Hospitals” attempts to bridge that gap, providing some concrete examples of different management practices. Our article builds on work by economists who developed a concise and powerful framework to study management in manufacturing. This measurement tool uses 18 questions covering four broad dimensions: Lean operations, performance monitoring, targets, and employee incentives. (One might think of these 18 questions as a sort of “MBA in a box.”) The approach has been validated in thousands of manufacturing surveys and serves as the basis for the newly introduced Management and Organizational Practice Survey (MOPS) component of the US Census.

One of the appeals of the 18 question approach is that it offers enough simplicity to quantify management while also being flexible to accommodate different ways of achieving similar goals.  Using this framework, we were able to gather detailed management data on more than 500 clinics. In a paper published in JAMA-Internal Medicine, we showed these practices were associated with higher quality and lower mortality. In the current paper, we demonstrate some of the variation in the use of these practices. By providing concrete examples of the different ways that hospitals are managed, we hope to advance the study and understanding of management in healthcare.

Many of the policies and efforts associated with the Affordable Care Act are likely to heighten the role of management practices and the ways in which they can drive performance. This is a rich opportunity for research. Good empirical studies of management may help light the way for a more efficient, high quality, patient-centered health care system.



John McConnell directs the Center for Health System Effectiveness at Oregon Health and Science University (OHSU) and is an Associate Professor in the Departments of Emergency Medicine and Public Health and Preventive Medicine at OHSU.

You can find his piece, “An Exploration of Management Practices in Hospitals”, here.


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