Academic journal article Frontiers of Health Services Management

Evidence-Based Management Reconsidered

Academic journal article Frontiers of Health Services Management

Evidence-Based Management Reconsidered

Article excerpt

SUMMARY

Reports of medical mistakes have splashed across newspapers and magazines in the United States. At the same time, instances of overuse, underuse, and misuse of management tactics and strategies receive far less attention. The sense of urgency associated with improving the quality of medical care does not exist with respect to improving the quality of management decision making. A more evidence-based approach would improve the competence of the decision-makers and their motivation to use more scientific methods when making a decision. The authors of this article consider a study of 68 U.S. health services managers that found a low level of evidence-based management behaviors. From the findings, four strategies are suggested to increase health systems managers' use of research evidence to improve decision making: focusing evidence-based decision making on strategically important issues, developing committees and other structures to diffuse management research throughout the organization, building a management culture that values research, and training managers in the competencies required to apply research evidence to health services management decisions. To aid the manager in understanding and applying an evidenced-based approach to decision making, the article provides practical tools, techniques, and resources for immediate use.

"What we do for and with patients and how we organize those efforts should, to the extent possible, be based on knowledge of what works. Put differently, both the application of clinical medicine and the application of organizational behavior should be evidence based. "

-Stephen M. Shortell, Ph.D., FACHE (Shortell 2001)

"What discourages our use of research is something that is typical of all health systems. That is, we are on a rapid cycle.... We don't have two years to study something. Sometimes having 40 percent of the information on something may be enough. We make a decision and change it if it doesn't work. "

-Health system manager (Kovner 2005)

The numerous developments in evidence-based decision making over the past decade should influence health organization leaders and managers to explicitly incorporate such decision making in their management processes. For example, the considerable use of evidence-based decision making by physicians has resulted in the proliferation of patient care guidelines and related decision-support materials for physicians (Sackett et al. 1996; Friedland 1998; Sackett et al. 2000; Geyman, Deyo, and Ramsey 2000; Eddy 2005; AHRQ 20063). Acceptance of the evidence- based approach has been growing in nursing, public health, health policy making, and other specialty areas in the health sciences (Lomas 2000; Donaldson, Mugford, and Vale 2002; Lavis et al. 2002; Stewart 2002; Lavis et al. 2003; Brownson .2003; Muir Gray 2004; Shojania and Grimshaw 2005; Hatcher and Oakley-Browne 2005; Fox 2005). As Muir Gray (2004) suggests, an evidence-based approach would improve the competence of decision makers and their motivation to use more scientific methods when making a decision. In their recent book, Management Mistakes in Healthcare, Paul Hofmann and Frankie Perry call for the identification, correction, and prevention of management mistakes in healthcare (Hofmann and Perry 2005). Moreover, articles have appeared in health management and health services research journals urging health services managers to examine the nature of decision making in their organizations and to consider adopting an evidence-based approach (Axelson 1998; Davies and Nutley 1999; Kovner, Elton, and Billings 2000; Walshe and Rundall 2001; Greenhalgh et al. 2004; Muir Gray 2004; Clancy and Cronin 2005). Web-based sources of evidence for managers have emerged, including compendiums of primary research studies and research syntheses developed by the Agency for Healthcare Research and Quality (http://www.ahrq.gov/research/), the Cochrane Effective Practice and Organization of Care Group (http://www. …

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