Evidence-Based Management in Healthcare: Principles, Cases, and Perspectives, Second Edition
413
Evidence-Based Management in Healthcare: Principles, Cases, and Perspectives, Second Edition
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Overview
Difficult decisions are part of everyday life for any manager, and the decisions that arise in the healthcare environment are far too important to be made based on poor information and gut feeling. An evidence-based approach to management ensures that healthcare leaders ask the right questions, use the best evidence available, and make better decisions in carrying out their mission. Evidence-Based Management in Healthcare: Principles, Cases, and Perspectives explains what evidence-based management is, how it can improve decision making, and, ultimately, how it can lead the way to improved organizational performance. This updated edition provides a thorough overview of evidence-based management, with an in-depth discussion of the framework, new and expanded case studies and examples, and interviews with experts in the field. Key topics include the following:
The definition of and rationale for evidence-based management The four main types of evidence The six steps of implementation Acquiring the best available evidence Barriers to evidence-based management and how to overcome them Perspectives from stakeholdersFeaturing contributions from a host of experts—including researchers, managers, leaders, and consultants—this book provides a practical and insightful complement to other organizational and management studies. New managers will find it a useful resource to have on hand in healthcare management settings of any kind.
Product Details
| ISBN-13: | 9781567938746 |
|---|---|
| Publisher: | Health Administration Press |
| Publication date: | 12/28/2016 |
| Series: | AUPHA/HAP Book |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 413 |
| File size: | 7 MB |
About the Author
Read an Excerpt
CHAPTER 1
EVIDENCE-BASED MANAGEMENT: THE BASIC PRINCIPLES
by Eric Barends, Denise M. Rousseau, and Rob B. Briner
Introduction
Consider this hypothetical situation: You pay a visit to a dietitian after gaining a bit of weight over the holiday season. The dietitian advises you to try diet X. It's very expensive and demands a radical change in lifestyle, but the prospect of having a slim and healthy body motivates you to stick to the diet. After a few weeks, however, you have gained five pounds and suffer serious side effects that require medical treatment. After searching the Internet, you learn that most scientific studies find diet X to be ineffective and fraught with such side effects. When you confront the diet consultant with these findings, he replies, "Why should I pay attention to scientific studies? I have 20 years of experience. Besides, the diet was developed by a famous American nutritionist whose book sold more than a million copies."
Does that sound like malpractice? It probably does. Unfortunately, in management, disregarding sound evidence, relying on personal experience, and following the ideas of popular management gurus are all too common. Such tendencies are especially troubling when you consider that managerial decisions affect the working lives and well-being of people around the world. Henry Mintzberg (1990, 60) once said:
No job is more vital to our society than that of a manager. It is the manager who determines whether our social institutions serve us well or whether they squander our talents and resources.
In this chapter, we will explain what evidence-based practice is and how it can help you and your organization make better decisions. Whether we work in a bank, hospital, large consulting firm, or small start-up company, we, as practitioners affecting the lives of so many, have a moral obligation to use the best available evidence when making decisions. We can do this by learning how to distinguish science from folklore, data from assertions, and evidence from beliefs, anecdotes, and personal opinions.
What Is Evidence-Based Practice?
The basic idea of evidence-based practice, or EBP, is that good-quality decisions should be based on a combination of critical thinking and the best available evidence. Although all management practitioners use evidence in their decisions, many pay little attention to the quality of that evidence. As a result, they make bad decisions based on unfounded beliefs and fads, leading to poor outcomes and limited understanding of why things go wrong. Evidence-based practice seeks to improve the way decisions are made. It is an approach to decision making and day-to-day work practice that helps practitioners to critically evaluate the extent to which they can trust the evidence they have at hand. It also helps practitioners to identify, find, and evaluate additional evidence relevant to their decisions.
In this chapter, we use a definition of evidence-based practice that also describes the main skills required. The definition, partly adapted from Dawes and colleagues (2005), is as follows:
Evidence-based practice is about making decisions through the conscientious, explicit, and judicious use of the best available evidence from multiple sources by
• asking (translating a practical issue or problem into an answerable question),
• acquiring (systematically searching for and retrieving the evidence),
• appraising (critically judging the trustworthiness and relevance of the evidence),
• aggregating (weighing and pulling together the evidence),
• applying (incorporating the evidence into the decision-making process), and
• assessing (evaluating the outcome of the decision taken) to increase the likelihood of a favorable outcome.
What Counts as Evidence?
When we say evidence, we basically mean information. It may be based on numbers, or it may be qualitative or descriptive. Evidence may come from scientific research suggesting generally applicable facts about the world, people, or organizational practices. Evidence may also come from local organizational or business indicators, such as company metrics or observations of practice conditions. Professional experience can also be an important source of evidence — for example, an entrepreneur's past experience in setting up businesses may suggest the approach that is most likely to be successful.
Think of it in legal terms. In a court of law, evidence is presented in a variety of forms, from eyewitness testimonies and witness statements to forensic evidence and security-camera images. All this evidence helps the judge or jury decide whether a person is innocent or guilty. The same is true for management decisions. Regardless of its source, all evidence should be included if it is judged to be trustworthy and relevant.
Why Do We Need Evidence-Based Practice?
Often, practitioners prefer to make decisions rooted solely in their personal experience. However, personal judgment alone is not a highly reliable source of evidence, because it is susceptible to systematic errors. Cognitive and information-processing limits make us prone to biases that have negative effects on the quality of decisions (Bazerman 2009; Clements 2002; Kahneman 2011; Simon 1997). Even practitioners and industry experts with many years of experience are poor at making forecasts or calculating risks when relying solely on their personal judgment. Such shortcomings have been found across a variety of areas, from the credit rating of bonds (Barnett-Hart 2009), to the growth of the economy (Loungani 2000), to political developments (Tetlock 2006), to medical diagnoses (Choudhry, Fletcher, and Soumerai 2005).
Practitioners also frequently take the work practices of other organizations as evidence. Through benchmarking and so-called "best practices," practitioners may copy what other organizations are doing without critically evaluating whether these practices are actually effective and, if they are, whether they are likely to work in a different context. Benchmarking can be useful in demonstrating alternate ways of doing things, but it is not necessarily a good indicator in itself of what will work in a particular setting.
Although the shortcomings we describe are well documented, many barriers still exist to evidence-based practice. First, few practitioners have been trained in the skills required to critically evaluate the trustworthiness and relevance of information. In addition, important organizational information may be difficult to access, and the information that is available may be of poor quality. Finally, practitioners are often not aware of the current scientific evidence concerning key issues in the field.
For example, a survey of 950 human resources practitioners in the United States showed large discrepancies between what practitioners think is effective and what the current scientific research shows (Rynes, Colbert, and Brown 2002). This study has been repeated in other countries with similar findings. The results suggest that most practitioners pay little or no attention to scientific or organizational evidence, instead placing too much trust in personal judgment and experience, "best practices," and the beliefs of corporate leaders. As a result, billions of dollars are spent on management practices that are ineffective or even harmful to organizations, their members, and their clients.
Case Example
Attributes Valued in a Manager
An American information technology company believed for years that technical expertise was the most important management capability. The company thought the best managers were those who left their staff to work independently and intervened only when people got stuck with a technical problem. However, when the company asked employees what they valued most in a manager, technical expertise ranked last. Attributes that employees considered more valuable included asking good questions, taking time to meet, and caring about employees' careers and lives. Managers who did these things led topper-forming teams, had the happiest employees, and experienced the lowest turnover of staff. These attributes of effective managers have been well established in scientific studies, so the company's improvement efforts could have been put in place years earlier.
What Sources of Evidence Should Be Considered?
Before making an important decision, an evidence-based practitioner first asks, "What is the available evidence?" Instead of basing a decision on personal judgment alone, an evidence-based practitioner finds out what is known by looking at multiple sources for evidence. According to the principles of evidence-based practice, four types of evidence should be taken into account:
1. Scientific evidence — findings from published scientific research
2. Organizational evidence — data, facts, and figures gathered from the organization
3. Experiential evidence — the professional experience and judgment of practitioners
4. Stakeholder evidence — the values and concerns of people who may be affected by the decision
The sources of these types of evidence are shown in exhibit 1.1 and discussed in the sections that follow.
Scientific Evidence
The first source of evidence is scientific research published in academic journals. Over the past few decades, the volume of management research has escalated dramatically, with topics ranging from evaluating merger success and the effects of financial incentives on performance to improving employee commitment and recruitment.
Much relevant research also comes from outside the management discipline, because many of the typical problems that managers face — such as how to make better decisions, how to communicate more effectively, and how to deal with conflict — are similar across a wide range of contexts. Many practitioners learn about research findings as students or through professional courses. However, new research is always being produced, and new findings often change our understanding. To ensure that up-to-date scientific evidence is properly included in decisions, a practitioner must know how to search for studies and judge how trustworthy and relevant they are.
Case Example
A Merger of Canadian Law Firms
The board of directors of a large Canadian law firm had plans for a merger with a smaller firm nearby. The merger's objective was to integrate the back office of the two firms (i.e., information technology, finance, facilities, etc.) to create economies of scale. The front offices and legal practices of the two firms were to remain separate. The partners had told the board that the organizational cultures of the two firms differed widely, so the board wanted to know whether such differences would create problems for the merger. Partners from both firms were asked independently about their experiences with mergers. Those who had been involved in one or more mergers stated that cultural differences did matter and could cause serious culture clashes between professionals.
How Scientific Evidence Helped
A search of online scientific databases yielded a meta-analysis based on 46 studies with a combined sample size of 10,710 mergers and acquisitions. The meta-analysis confirmed the partners' judgment that a negative association existed between cultural differences and the effectiveness of postmerger integration. However, the study also indicated that this association was only the case when the intended level of integration was high. In mergers that required a low level of integration, cultural differences were found to be positively associated with integration benefits. In the case of the two law firms, the planned integration concerned only back office functions, making the likelihood of a positive outcome higher.
Organizational Evidence
A second source of evidence is the organization itself. Whether for a business, hospital, or governmental agency, organizational evidence comes in many forms. It can be financial data, such as cash flow or costs, or it can be business measures, such as return on investment or market share. It can come from customers or clients in the form of customer satisfaction, repeat business, or product returns statistics. It can also come from employees through information about retention rates or levels of job satisfaction. Organizational evidence can consist of "hard" numbers such as staff turnover rates, medical errors, or productivity levels, but it can also include "soft" elements such as perceptions of the organization's culture or attitudes toward senior management. Organizational evidence is essential to identifying problems that require managers' attention. It is also essential to determining likely causes of problems, plausible solutions, and what is needed to implement these solutions.
Case Example
Considering a Change in Structure
The board of a large insurance company had plans to change from a regionally focused structure to a product-based one. According to the board, the restructuring would improve the company's market presence and drive greater customer focus. The company's sales managers, however, strongly disagreed with the change. They argued that ditching the regional structure would hinder the building of good relationships with customers and therefore harm customer service.
How Organizational Evidence Helped
Analysis of organizational data revealed that the company's customer satisfaction was well above the industry average. Further data analysis revealed a strong negative correlation between account managers' monthly travel expenses and the satisfaction rates of their customers, suggesting that sales managers who lived close to their customers scored higher on customer satisfaction. This evidence convinced the board to retain the regional structure after all.
Experiential Evidence
A third source of evidence is the professional experience and judgment of managers, consultants, business leaders, and other practitioners. Different from intuition, opinion, or belief, professional experience is accumulated over time through reflection on the outcomes of similar actions taken in similar situations. This type of evidence is sometimes referred to as "tacit" knowledge.
Professional experience differs from intuition and personal opinion because it reflects the specialized knowledge acquired through repeated experience and the practice of specialized activities — whether playing the violin or making a cost estimate. Many practitioners take seriously the need to reflect critically on their experiences and distill the practical lessons. Their knowledge can be vital for determining whether a management issue really does require attention, if the available organizational data are trustworthy, whether research findings apply in a particular situation, or how likely a proposed solution is to work in a particular context.
Case Example
Personal Development Plans
A university hospital decided to ask its nurses to compile personal development plans, which were to include a statement of each nurse's aspirations and career priorities. The human resources (HR) director pointed out that, according to Abraham Maslow's hierarchy of needs (a well-known theory about motivations), basic levels of needs (e.g., health, safety) must be met before an individual can focus on higher-level needs (e.g., career and professional development). The nurses at the emergency department were increasingly exposed to serious safety hazards, including physical violence. The HR director therefore recommended that these nurses be excluded from the program until the safety hazards had been substantially reduced.
How Experiential Evidence Helped
Experienced managers and nurses were asked independently for their views on the HR director's recommendation. Most of them disagreed with the recommendation, and they indicated that their experience suggested that the opposite was often the case — that nurses who worked in difficult circumstances tended to be strongly interested in professional development and self-improvement. Additional evidence was harvested from online scientific databases, where a range of studies showed a lack of empirical evidence supporting Maslow's theory. The nurses' view therefore prevailed.
Stakeholder Evidence
A fourth source of evidence is stakeholder values and concerns. Stakeholders are any individuals or groups who may be affected by an organization's decisions. Internal stakeholders include employees, managers, and board members. Stakeholders outside the organization may include suppliers, customers, shareholders, the government, and the public at large. Stakeholder values and concerns reflect what stakeholders believe to be important, which in turn affects how they tend to react to the possible consequences of the organization's decisions.
(Continues…)
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Table of Contents
Foreword — David Blumenthal,
Acknowledgments,
An Introduction — Anthony R. Kovner and Thomas D'Aunno,
Part I Overview,
Chapter 1. Evidence-Based Management: The Basic Principles Eric Barends, Denise M. Rousseau, and Rob B. Briner,
Chapter 2. Rapid Evidence Assessments in Management: An Example Eric Barends, Karen Plum, and Andrew Mawson,
Part II Scientific Evidence — Doing the Work,
Chapter 4. Research Opportunities and Examples Thomas Rundall and Terese Otte-Trojel,
Chapter 5. Acquiring Evidence Susan Kaplan Jacobs,
Chapter 6. Barriers to the Use of Evidence-Based Management in Healthcare ... and How to Overcome Them Thomas D'Aunno,
Chapter 7. Learning from Other Domains Denise M. Rousseau and Brian C. Gunia,
Part III Scientific Evidence — Examples of Practice,
Chapter 8. Case Study: The Evolution of Evidence-Based CEO Evaluation in a Multi-Unit Health System Lawrence Prybil and Michael Slubowski,
Chapter 9. Case Study: The Healthy Transitions Program in Late Stage Kidney Disease Sofia Agoritsas, Steven Fishbane, and Candice Halinski,
Chapter 10. Case Study: Evidence-Based Criteria for Hospital Evacuation, Ten Years After Hurricane Katrina K. Joanne McGlown, Stephen J. O'Connor, and Richard M. Shewchuk,
Chapter 11. Case Study: Integrated Chronic Care Management and the Use of Evidence in Decision Making Kyle L. Grazier,
Part IV Organizational Evidence,
Chapter 12. Engineering, Evidence, and Excellence: The Kaiser Permanente Example Jed Weissberg and Patrick Courneya,
Chapter 13. Big Data and Evidence-Based Management at Lyndon B. Johnson General Hospital Jessie L. Tucker III,
Chapter 15. Teaching Capstone at NYU Wagner: Demonstrating Competency and Applying the Principles of Evidence-Based Management John Donnellan,
Chapter 16. The Consulting Approach as an Application of Evidence-Based Management: One Firm's Experience Kim Carlin,
Part V Experiential Evidence,
Chapter 17. Experience of a Hospital Manager Lynn McVey and Eric Slotsve,
Chapter 18. How to Do Evidence-Based Management: A Demonstration Bryce Clark,
Chapter 19. Perspective on Hospital Performance: Interview with David Fine, President and CEO, Catholic Health Initiatives Institute for Research and Innovation, Englewood, Colorado,
Chapter 20. Perspective on Hospital Performance: Interview with Richard D'Aquila, President, Yale New Haven Hospital,
Chapter 21. Perspective on Hospital Performance: Interview with Michael Dowling, CEO, Northwell Health,
Part VI Stakeholder Concerns,
Chapter 22. Perspective on Medicine: Interview with Ethan Basch, MD, University of North Carolina,
Chapter 23. Perspective on Nursing: Interview with Maja Djukic, Assistant Professor, Rory Meyers College of Nursing, New York University,
Chapter 24. Perspective on Big Data: Interview with John Billings, Professor, NYU Wagner,
Chapter 25. Perspective on Evidence-Based Practice: Interview with Eric Barends, Center for Evidence-Based Management, Amsterdam, the Netherlands,
Chapter 26. Perspective on Hospital Performance: Interview with Quint Studer, Studer Group, Pensacola, Florida,
Chapter 27. Evidence-Based Management: Where Do We Go from Here? Anthony R. Kovner and Thomas D'Aunno,
Appendix A: A Course Reference Guide on Evidence-Based Management — Eric Barends,
Appendix B: Starter Set of Additional Readings About Evidence-Based Management in Healthcare — Anthony R. Kovner,
Index,
About the Editors,
About the Contributors,