Transcript Evidence-informed management decision

INTERNATIONAL CONFERENCE ON
EVIDENCE-BASED BEST PRACTICE
GUIDELINES
EVIDENCE-INFORMED MANAGEMENT
DECISION-MAKING: IS IT A
POSSIBILITY IN HEALTHCARE?
07 June 2007
Crucial to finding the way is this:
there is no beginning or end.
You must make your own map.
Joy Harjo
A Map to the Next World: Poems
REFLECTIONS
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Setting the Context re EvidenceInformed Decision-Making
What is Evidence?
Cautions re Status of EvidenceInformed Decision-Making
Your Roles as Leaders and Champions
APPROACHES TO EVIDENCE
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Decision-makers = evidence viewed
colloquially, anything that establishes a
fact or gives reason for believing
something, defined by relevance
Researchers = evidence viewed
scientifically, use of systematic and
replicable methods for production, defined
by methodology
 Emphasis on context-free universal truths
(evidence based medicine)
 Emphasis on context-sensitive role for
evidence in particular decision (applied social
science)
WHO DEFINIITON OF
EVIDENCE
Findings from research and other
knowledge that may serve as a
useful basis for decision-making
in public health and health care.
World Health Organization
Europe (2004)
UK GOVERNMENT DEFINITION
OF EVIDENCE
The raw ingredient of evidence is information. Good
quality policy making depends on high quality
information, derived from a variety of sources —
expert knowledge; existing domestic and
international research; existing statistics;
stakeholder consultation; evaluation of previous
policies; new research, if appropriate; or
secondary sources, including the internet.
Evidence can also include analysis of the outcome
of consultation, costings of policy options and the
results of economic or statistical modeling.
U.K. Government Policy Hub (1999)
CHSRF DEFINITION OF
EVIDENCE
Evidence is information that comes closest to the
facts of a matter. The form it takes depends
on context. The findings of high-quality,
methodologically appropriate research are the
most accurate evidence. Because research is
often incomplete and sometimes contradictory
or unavailable, other kinds of information are
necessary supplements to or stand-ins for
research. The evidence base for a decision is
the multiple forms of evidence combined to
balance rigour with expedience – while
privileging the former over the latter.
CHSRF (2006)
WHY EVIDENCE IS
IMPORTANT
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Improved patient health outcomes
Improved population health outcomes
Cost containment
Quality improvement
Accountability
Responsiveness in a new age
Can it work?
Will it work?
Is it worth it?
WHY EVIDENCE MUST BE
INTERPRETED – what, how, who
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Inherent uncertainly usually
accompanying evidence – definitive
studies rare
Complexity of decisions and
improbability of evidence being
comprehensive
Need for actors to create meaning and
interpret evidence before it becomes
“knowledge”
Evidence is uncertain, dynamic,
complex, contestable, rarely complete
UNDERLYING PRINCIPLES
Accountability
 Transparency
 Quality
 Inclusiveness
 Reliability
 Responsiveness
 Explicitness
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CATEGORIES OF EVIDENCE
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Research evidence = accepted research
methodologies
Organizational evidence = information
about organization’s capacity to complete
the task, e.g., human resource
requirements, availability of managerial
expertise, reality of limited budgets
Political evidence = public attitudes
towards proposed policies, media reaction
Rudolph Klein (2004)
CATEGORIES OF EVIDENCE
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Context-free scientific evidence =
medically oriented effectiveness
research
Context-sensitive scientific evidence =
social science oriented research
Colloquial evidence = expertise, views
and realities of stakeholders
Lomas, et al (2005)
CONTEXT-SENSITIVE
SCIENTIFIC EVIDENCE
Attitudes
 Implementation
 Organizational capacity
 Forecasting
 Economics/finance
 Ethics
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COLLOQUIAL EVIDENCE
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Resources
Expert and professional opinion
Political judgment
Values
Habits and traditions
Lobbyists and pressure groups
Pragmatics and contingencies of
situation
DELIBERATIVE PROCESS
A deliberative process is a tool for producing
guidance based on heterogeneous evidence.
It is a participatory process that includes
representation from experts and
stakeholders, face-to-face interaction,
criteria for the sources of scientific
evidence and their weight, and a
mechanism for eliciting colloquial evidence
while making it subsidiary to the science.
CHSRF (2006)
ARGUMENTS FOR
DELIBERATIVE PROCESSES
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Eliciting and Combining Evidence
Democratic Governance
Creating Acceptable Guidance
SUCCESS OF
DELIBERATIVE PROCESSES
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Presence of strong chairperson
Different types of evidence
Engagement of scientific and decisionmaking communities
Explicit process of exclusion/inclusion
Face-to-face discussions
Appropriate timelines for questions
Mechanism to elicit values of participants
Venue for expressing minority views
CAUTIONS RE EVIDENCE
INFORMED DECISION-MAKING
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It is early days yet for evidence-informed
decision-making.
Evidence-informed decision-making and
change management are intertwined.
“Evidence” is more than research in
“evidence-informed decision-making.”
Evidence-informed decision-making is
sustained through personal relationships.
There is need for an evidence-informed
decision-making infrastructure.
INFLUENCING THE
FUTURE
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Hold the vision
Know your strengths
Develop new skills/competencies
Envision creatively the ways
Build on the best
Be patient but persistent
Be collaborative but challenging
WALKING THE LABYRINTH
CHSRF REFERENCES
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J. Lomas, T. Culyer, C. McCutcheon, L.
McAuley & S. Law, “Conceptualizing and
Combining Evidence for Health System
Guidance,” May 2005.
“Weighing up the evidence: Making evidenceinformed guidance accurate, achievable, and
acceptable,” A Summary of the Workshop held
on September 29, 2005.
“WHAT COUNTS? Interpreting evidence-based
decision-making for management and policy,”
Report of the 6th CHSRF Annual Invitational
Workshop, Vancouver, British Columbia, March
11, 2004.
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Received Wisdoms: How health systems are
using evidence to inform decision-making,
CHSRF, 2007.
BLESSING
May the light of your souls guide you.
May the light of your souls
bless the work that you do
with the secret love and warmth of your
hearts.
May you see in what you do
the beauty of your own souls.
May the sacredness of your work
bring healing, light and renewal
to those who work with you
and to those who see and receive your work.
May your work never weary you.
May it release within you wellsprings of
refreshment, inspiration and excitement.
May you be present in what you do.
May you never become lost in bland absences.
May the day never burden.
May dawn find you awake and alert,
approaching your new day with dreams,
possibilities and promises.
May evening find you gracious and fulfilled.
May you go into the night
blessed, sheltered and protected.
May your souls calm, console and renew you.
Adapted from
John O'Donoghue, Anam Cara