Run faster to run faster

To run faster you have to run faster. This training instruction kept going through my head this morning as I was pounding out the 4 mile run with my running partner Carolyn. I have been a pretty steady 10 minute mile pace runner for a very long time, except 4 years ago when my pace was closer to 8 minute miles. During that time period 4 years ago I was running faster to run faster, and it worked. This seems so relevant to what is happening now in health care; we have to run faster.

Health care doesn’t have a lot of experience in making fast changes. A longitudinal study of hospitals by Marlin, Hounker, and Hasbrouck (2004) showed that health care organizations with strategic initiatives are different than companies in other industries. While other industries will try to differentiate themselves from competitors, health care organizations copy each other. How is that running faster? To run faster we have to do change it up; short bursts of higher intensity to feel the burn. As health care organizations we have to implement pilot studies and try new ideas. We have to get them off the design table and into operations quickly. If it works, great. If it doesn’t work, move on to something else.

So this morning I put a sprint into the last quarter mile, pushing as hard as I could knowing the end was literally in sight. I may not make it back to the 8 minute miles, and really I don’t care about the time because I am not competing with anyone. However, a few sprints in the day will enhance my effect. I think the same is true for our organizations.

Marlin, D., Huonker, J. W., & Hasbrouck, R. B. (2004). Navigating turbulent times:
Strategic groups and performance in the hospital industry, 1983 to 1993.
Organizational Analysis, 12(2), 91-107.

Where is the evidence?

When the evidence is there, why don’t we use it? My concern is provoked by the research of Pfeffer and Sutton (2006) who indicate that only 15% of medical decisions are evidence-based. This is startling, and probably worse for management decisions. Pfeffer and Sutton suggest obsolete knowledge, personal experience, specialist skills, hype, dogma, and mindless mimicry of top performers. That is not reassuring.

How can managers be more mindful of research and approach questions and problems with empirical evidence? The first step is to check the literature for what is known about the topic. Perhaps little research exists, or what exists are small studies. That’s okay; it is a start and at least you know what has been published. Professional associations, such as MGMA (www.mgma.com), give members access to literature databases. These are great tools for searching for research studies. Be careful of mindless chatter in print. If information is just being put forward without data or theory to support the premise, be cautious. A claim can be made for anything to be right or true, but evidence speaks louder than just words. When looking in a literature database, search for articles that have been “peer reviewed”. This means that the article and research has been put through a blind review by similar professionals and found acceptable for the publication. Managers who look at the literature first will improve their understanding of the topic before moving forward with changes.

Recently I was considering the topic of patient recall and the process clinics use to encourage patients to have follow up or health promotion visits. I found in the literature many studies on how patients choose their doctor for the first visit, and a few studies on what makes patients continue with the doctor after the first visit. So how does recall fit into this? I’m not sure yet. I think it has to do with continuity, but also convenience. I will dive into this deeper to see what comes up. There is definitely room for more studies on this topic. If we understand how recall is part of the decision making in seeing physicians we can better plan for processes that support the decision making. So much to do, so little time.


Pfeffer, J., & Sutton, R. I. (2006). Evidence-based management. Harvard Business
Review, 84(1), 62-74.