1. Section Editor(s): Carroll, V. Susan Editor

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In the film Money Ball, the Oakland Athletics' General Manager Billy Beane faces the challenge of assembling a competitive team-with limited financial resources-following a disappointing postseason loss. As he struggles to draft "talent," he meets Paul, a Yale graduate with a degree in economics, who has a unique theory about assessing players' value prior to signing. Billy and Paul implement a review of potential players that looks at what players have done-that is, at the statistical reality of their experience. Players were then selected using the scientific method, testing hypotheses by analyzing historical statistical data rather than by referring to the wisdom of "old baseball men." So, although ostensibly a film about baseball, Money Ball is a film about business and life. But, can it relate to healthcare?

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Beane used evidence to make decisions. He and his geeky economist advisor systematically searched for and appraised the most relevant evidence to answer questions of whom to draft; they conducted the equivalent of meta-analyses in their appraisals. Similar to the process of evidence-based clinical decision making, Beane gathered evidence from the players themselves-their histories and their expertise. And, as in clinical decision making, he evaluated resource availability. The Oakland A's lack of funds meant the team would be unable to sign any famous baseball stars. They would have to make player choices carefully to manage their budget. Beane carefully evaluated the worth of each player and each trade-was there a positive cost-benefit ratio?


Beane's approach to creating a successful, competitive team also mirrors typical quality improvement processes. Identify a problem. Choose a team. Brainstorm and identify options. Implement and evaluate the plan. He moved the team forward with a Plan-Do-Study-Act (PDSA) approach to improvement and change. One of his cardinal rules for managing the team was that no matter how successful you are, change is always good. Beane challenged the status quo; he was continuously upgrading, looking at the long-term big picture.


His willingness to change meant that Beane challenged the institutionalized knowledge or lore that was a part of baseball history. Nurses also work using a storehouse of institutionalized knowledge-a very different set of facts to be sure, but information that has not been modified consistently as the healthcare world rapidly shifts and changes. We have not always been eager to evaluate our own systems to keep the good and eliminate the bad.


Under Beane's direction, the Oakland Athletics' outcomes improved; he believed in setting goals and planning systematically to achieve them. The team won more often; they went to the playoffs again. And, although winning isn't everything in healthcare, unlike in professional sports, we too strive for "wins"-excellent quality care, positive outcomes, strong publicly reported quality measures, and a strong bottom line. We cope with business and life every day.


Beane's greatest achievement may be that he introduced the idea of rationally managing a baseball team that is used today by most major league teams. What can we learn? Play ball-Beane's way!

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