Make Room for the Little Guy

By Scott Harris

Interest in health services research is exploding. Thanks to a renewed focus on cutting costs and improving care, the study of not only what to do but how to do it is an increasingly high priority. Household names like Harvard, Hopkins, and Geisinger all have health services research enterprises.

So what’s unusual about the Western Connecticut Health Network (WCHN)? Unlike other institutions working in health services research, WCHN has “only” two hospitals, 456 total beds, and a bottom line that isn’t, well, bottomless.

Nevertheless, leaders at WCHN are committed to health services research and the rewards it can bring.

“For every big hospital or academic medical center, there are 20 our size,” said Ramin Ahmadi, MD, MPH, WCHN’s director of research and medical education. “To improve care nationally, we can’t just rely on a few large institutions. The question isn’t how big you are. It’s whether you can focus your resources on the issues that are important to you.”

Since it began four years ago, the WCHN Clinical Outcomes and Health Services Research program has explored and engineered new ways of handling a range of conditions, from sleep apnea to aspirin sensitivity. Most recently, researchers at WCHN’s Danbury Hospital studied patients who underwent inpatient transthoracic echocardiography to determine whether the procedure was appropriate to the situation. The findings appeared in the September edition of the Journal of the American Society of Echocardiography. At Danbury, the study resulted in more supervision and collaboration between attending physicians and cardiologists.

“It’s not so much that we have a problem to address, it’s that there are areas we simply don’t know much about,” Ahmadi said. “It’s like a black box. We wanted to know more about our costs. Could we lower them? Are we providing good care? Are we following the guidelines for appropriate use? And would following those guidelines help us in our aims?”

According to Ahmadi, hard data on WCHN’s cost savings are not available, though he said the research findings are bearing fruit. In some ways, being smaller can actually be an advantage.

“You can move more quickly and be more universal in your adaptation of a new process,” Ahmadi said. “Redesigning a process is a tremendous task. But in a smaller organization, you can reach into the corners faster and evaluate your changes more efficiently.”

At the same time, smaller institutions and networks must be more careful about how they use resources to conduct the research as efficiently as possible and within existing budgets and org charts.

“You need research coordinators who can multitask, so that you save on human resources,” Ahmadi said. “We train associates and coordinators from day one to make sure they’re equipped for the job. You have to have a team that understands the goal.”

Ahmadi acknowledged that, in order to conduct health services research, hospitals probably need to be regional in scope and have access to large data sets. So there would seem to be a size minimum.

Anecdotally speaking, Ahmadi said he’s noticed more smaller hospitals competing for federal grants around health services research.

“The big guys look at this and compete for these grants,” Ahmadi said. “Why not us?”