Healthcare managers

1
Healthcare managers their non-clinical decision
making

• What information do they need and use?

Jackie MacDonald Annapolis Valley Health, South
Shore Health South West Health Centre for
Health Information Management Research,
Department of Information Studies, University of
Sheffield Peter Bath Department of Information
Studies, University of Sheffield Andrew
Booth School of Health and Related Research,
University of Sheffield
2
Presentation Outline

• Why
• Background
• Literature Review Conceptual Framework
• What?
• Study questions
• How?
• Study design, data analysis, reporting
• Selected findings related to this presentation
• Phase II

3
Some change factors in our health care workplace

• Increasing costs for print information
• The information explosion
• Healthcare system reorganization
• Advances in technology, health medicine,
  electronic information
• Evidence based clinical practice
• Population health
• Funding cuts
• Convergence of LIS/IM/IT/HIM/knowledge broker and
  other roles
• Open access publishing

4
Research questions

• Related to this presentation
• In what roles are healthcare managers engaged
  when faced with making decisions?
• What information do they need?
• How do they determine they have enough
  information?
• What are their information issues and problems?
• Are these healthcare managers typical?

5
Phase 1 Research Design

• Approach Qualitative
• Data Gathering
• 19 semi-structured interviews, with a warm up
  question
• Critical Incident Technique
• General questions
• Knowledge of population health.

6
Phase 1 Data Analysis

• Data Analysis Synthesis
• Taped interviews transcribed verbatim, then
  categorically indexed (526 terms) ATLASti
• NATCEN Framework for cross case synthesis
• Units of Analysis
• Information sources used in each case
• The approach to information seeking in each case.

7
Phase 1 Findings Reporting

• Four Broad Themes
• Information and Decisions
• Information and Sharing
• Information and Seeking
• Information and Population Health

• Data Reporting
• Integrated results and discussion
• Explanations supported with quotations or
  research literature.

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Work Roles Decision Complexity

• Decision Complexity
• Unstructured decisions
• Administrative policy decisions
• Multi-level decisions
• Naturalistic Decision Making Mode
• Decision Phases 1-3
• Problem-Opportunity decisions
• Group decisions

• Managers Work Roles
• Interpersonal Role
• Leader
• Decisional Role
• Improver/Changer
• Information Processing
• Monitor

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When did they look for information?

• Simon/Mintzbergs Decision Making Phases
• Phase 1 Identification/Intelligence
• Looked for information at 5 points
• Phase 2 Design/Development
• Looked for information at 7 points
• Phase 3 Choice/Selection
• Looked for information at 6 points
• Phase 4 Implementation Review
• Looked for information at 2 points
• (please see Figure 1, slides handout)

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What information did they look for?

• Explicit knowledge
• Organizational values, Organizational
  considerations, Regulations, Resources
• Cultural knowledge
• Situational variables, Environmental variables
• Tacit knowledge
• Task importance, likelihood of successful
  implementation, sustainability
• Gaps Information, Information Management,
  Capacity, Understanding, Resources
  (please see Figure 2, slides handout)

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Did they have enough information?

• I said I didn't find all the information that I
  needed. I still don't have other policies and
  procedures that I wish that I had. I think I did
  an ok job. (Manager)
• There is also a time sensitivity to this a
  decision on time is better than the right answer
  too late... all tied up in a nice bow (Senior
  Executive).

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Where did they get their information?

• There are some people, if they told me something,
  I would take it with a grain of salt and would
  question where they got their information. There
  are other people that I have respect for and know
  their information is very reliable. (Director)

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What were their information access problems and
challenges?
We are trying to gather information on clinic
utilization and figure out how to interpret
information - we dont have as much information
and are not 100 sure of what it means.
(Director)
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Two theories to test in Phase II

• Healthcare managers do use research information
  to support decision making, but not always they
  are more likely to consider it if after their
  more basic information needs are met.
• More successful information gatekeepers know what
  they know and also what they dont know. They
  keep up with the research literature and with
  what is going on within their own healthcare
  organization and synthesize these with their own
  experience and expertise.

15
The role of a librarian is to make sense of the
world of information. If that's not a
qualification for superhero-dom, what is?
Nancy Pearl Thank you. Questions?