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CTSI: Efficiency and Cost Effectiveness

The recent intense attention to reducing costs of health care needs to be applied similarly to research: the high costs of research - both in terms of dollars and time - are no longer acceptable. Biomedical research, similar to healthcare delivery, has become a business and there is a need for a business model to address the sustainability and efficiency of healthcare research. The UM CTSI is uniquely positioned to transform the healthcare research enterprise, not only at UM but across all CTSIs, by combining exceptional clinical, research and business expertise across UM CTSI institutions, including UMB, UMCP and Geisinger Health System.

The “business of research” requires that research enterprises, including those at leading academic medical centers, will need to transform their standard operating procedures in order to become more efficient and conduct research in a cost-efficient manner. Efficient research enterprises support shared resources and develop project management strategies for individual projects as well as programmatic plans for a research agenda and for continued organizational sustainability. An essential component of efficiency in research is tracking and assessing the costs of conducting research to provide input for benchmarking and budgeting. This will allow the UM CTSI and other CTSAs that track similar metrics to plan more efficiently and develop best practices for streamlining research processes to produce high-quality research at reduced costs and with shorter lag times.

Approach

The internal evaluation process of UM’s CTSI will be designed to support the transformation of the UM research enterprise to enhance quality and efficiency in research. The tracking, assessment and evaluation processes will be constructed on a robust foundation of scientific program evaluation methods and performance management techniques. The proposed efficiency and cost-effectiveness evaluation plan explicitly recognizes that the by the CTSI represents a business enterprise (one whose primary mission is institutional environment created research) that seeks to utilize its resources effectively and efficiently to produce the desired outputs of high quality research, high-speed science, innovation, and resource leveraging. We propose a multi-dimensional assessment of efficiency, quality and cost-effectiveness of programs and activities of the CTSI that builds on the conceptual foundation of a widely-used and powerful performance assessment tool: the Balanced Scorecard (BSC) [58]. Although originally constructed for for-profit enterprises, the BSC model has become increasingly popular within the public sector. The “core” of the 850 is the balance between financial and non-financial indicators of success, between lag and lead indicators of success, and between internal and external stakeholders. We will adapt the BSC to the needs of the CTSI program evaluation. The underlying logic model is an outcomes-based approach, where specific metrics that represent the desired outcomes of all CTSI programs and activities are included. Each measurement sub-dimension will be evaluated using a set of metrics specifically constructed to ensure the accomplishment of the enterprise’s mission.

Our evaluation plan operationalizes the measurement subdomains shown in Figure 2.7 with the metrics in Table 2.6. We include both qualitative and quantitative measures. The proposed evaluation is innovative in that it applies the principles of managing a business enterprise to the domain of a translational research infrastructure that involves multiple partnerships and collaborations between different sets of stakeholders. The set of metrics included in our evaluation plan include those focused on the efficiency of the CTSI (e.g., the average time for IRB protocol approval, standardization of research procedures, time taken for a new researcher to become productive, average cost of RCT5), as well as effectiveness (the extent to which the CTSI is fulfilling its mission related to outcomes such as the generation of new scientific knowledge, building capacity through training and development, and the development and sustainability of community engagement in research.) We will benchmark the CTSI against its own performance over time, utilizing historical data as the comparison to isolate improvements in performance across all domains over time. We will also utilize data collected and reported by the CTSA Consortium Coordinating Center that currently serves as the overall coordinating body for existing CTSAs across the nation.

In conclusion, the proposed tracking, assessment, and evaluation of the UM CTSI is theory-driven and rests on a solid conceptual foundation that tracks and balances performance metrics across four key dimensions. Successful implementation of the balanced scorecard approach will address the needs of internal and external stakeholders and facilitate learning and growth to promote quality research and efficiency to achieve sustainability. The UM CTSI balanced scorecard approach objectively tracks the extent to which the CTSI is accomplishing its mission and can serve as a model for other CTSIs.