Transcript New and Enhanced Skills Required by Health Professionals

Evidence-based
Management:
Translating Research into
Practice
Annual Meeting of AcademyHealth
2004
How Managerial Decisions
Are Typically Made in
Health Service
Organizations
Think of the last time your organization
(or subunit) faced a managerial problem,
such as:
 relatively high rates of medical errors across the
organization
 workforce supply shortage
 poor hospital-physician relations
 adoption of new technology
 declining market share
What decision did your organization’s
managers make? How did they make
this decision?
Top Ten Approaches to
Managerial Decision
Making
1. Do nothing
2. Copy what other
organizations have done
3. Use intuition and
experience of leader(s)
4. Seek expert consultation
5. Seek leadership team
consensus
6. Examine relevant
cases
7. Model and forecast
8. Review relevant piece
of management
research
9. Conduct study to
assess alternatives
10. Apply evidence-based
decision making
The “Usual” Approaches
to Managerial Decision
Making Often Produce
Ineffective Actions
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Overuse
Underuse
Misuse
Overuse
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Underuse
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Misuse/variat ion
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The usage of organizat ional mergers as a response to problems of
service quality, capacit y or financial viability in health care
organizat ions (Blumenthal and Edward s 2000; Arndt, Bigelow and
Dorman 1999)
The measurement of patient satisfact ion using poorly conceptualised
and designed inst ruments which produce data that are oft en not used
(Sitzia and Wood 1997; van Campen, Sixma, Friele et al 1995)
The replacement of physicians with other health professionals in
providing many rout ine health services especially in set t in gs like
primary care and accident and emergency depart ments (Richardson,
Maynard, Cullum et al 1998; Richards, Carley, Jenkins-Clarke et al
2000)
The concentration of workload for part icular procedures at
inst itut ions which handle substant ial volumes of those procedur es
and have bet ter pat ient out comes (Dudley, Johansen, Brand et al
2000; Luft, Bunker and Enthoven 1979)
The use of community-based t reat ment (“ hospital at home” schemes
and the like) as an alternat ive to hospit al inpat ient care (Shepperd
and Iliffe 1998).
The involvement of clinicians in the management of health care
provider organizat ions, and the st ructuring of clinical management
arrangements (Succi and Alexander 1999; Guthrie 1999)
The adopt ion and implementat ion of total quality management or
cont inuous quality improvement init iat ives (Shortell, Bennet t and
Byck 1998; Blumenthal and Kilo 1998)
Can Health Management
Research:
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Improve financial performance?
Improve quality of care and patient
outcomes?
Improve consumer/patient access
to care?
The Key Principles of
Evidence-Based
Management
Evidence-based management is part of a
larger movement to strengthen evidencebased decision making in health service
organizations. Evidence-based decision
making is defined as:
“the systematic application of the best
available evidence to the evaluation of
options and to decision making in clinical,
management, and policy settings.”
What is evidence-based management?
At the core of evidence-based management is the
notion that health managers should incorporate
into their decision making evidence from well
conducted management research, thereby
minimizing the problems of overuse, underuse,
and misuse of organizational problem solving
strategies and operational procedures.
Evidence-based
management is the
integration of:
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Managerial expertise
Organizational mission and values
The best available evidence
into the decision-making process.
Managerial expertise =
The manager’s cumulated experience, education,
and managerial skills
Organizational mission and values =
The core values and beliefs promoted by the
organization’s leaders and internalized by its
managerial and clinical staff.
Best available evidence =
The methodologically strongest research
available at the time a decision must be made.
What types of evidence
can be incorporated in
evidence-based
management?
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Meta-analyses
Systematic reviews
Evaluations using experimental designs
Evaluations using quasi-experimental
designs
Observational studies
Expert committee assessments
Personal experience
The evidence, by itself, does not make the
decision for you, but it can increase your
understanding of the expected effects of
managerial decisions. The full integration
of these three components into managerial
decisions enhances the opportunity for
improving organizational performance on
the criteria most highly valued by the
organization.
Some Ways EBM Has
Improved Organizational
Performance in Health
Service Organizations
In conclusion, management
research evidence can
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Complement - not
replace - the
many other forms
of data and
knowledge that
go into making
decisions;
Help managers
and policy makers
evaluate the
feasibility and
potential impact
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Make it easier to
explain where
decisions came
from;
Help in
negotiations
between interest
groups and
competing
arguments;
Increase
What are the Characteristics
of a Health Service
Organization that Facilitate
Evidence-Based Management?
Imagine being a manager in an
organization with high performing
evidence-based management
support…
Some characteristics of
organizations that
practice evidence-based
management
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Chief Knowledge Management Officer
Training in evidence-based
management
(e.g. locating and using research
syntheses)
Management Journal Club
Evidence Assessment Teams
Management Research Seminars
What can managers do to
better prepare their
organization to practice
EBM?
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Start by working with colleagues to
complete an assessment of the
organization’s ability to:
– Acquire evidence
– Assess evidence
– Adapt its format
– Apply it in decisions
Even if you’re on the right
track,
you’ll get run over if you
just sit there.
Will Rogers