Evidence-Based Management in Healthcare
Hernandez, S. Robert, Inquiry
Evidence-Based Management in Healthcare. By Anthony R. Kovner, David J. Fine, and Richard D'Aquila. Chicago: Health Administration Press. 2009. 298 pp. $79 (paper).
Evidence-based practice has received increased attention in the health care sector over the past 20 years. Much of the impetus for this movement results from the value that medicine has associated with seeking a better understanding of outcome probabilities with treatments for selected disease processes. While there has been some criticism of evidence-based medicine, the principles for this approach have been fairly widely accepted in medical care delivery. This concept also has been touted for application in public health. Ross Brownson and colleagues (Evidence-Bused Public Health, New York: Oxford University Press, 2003) extended the value of applying scientific evidence in making management decisions, policy development, and program implementation to public health issues. Their approach focused on using evidence to address population health topics and relate public sector issues in an attempt to achieve maximum return from public health expenditures.
More recent discussions have focused on extending evidence-based practice to management. In her 2005 presidential address to the Annual Meeting of the Academy of Management, Denise Rousseau suggested that management had not benefited from organizational research and that the "research-practice gap'" needs to be closed if managers are to take action and base decisions on the best available evidence. One of her recommendations for closing this gap was for the development of models of evidence-based practice to be used as a guide for practitioners. Another suggestion was for the development of collaboration among managers, researchers, and educators to change the manner in which we educate students in professional schools.
Anthony Kovner and his colleagues' recent work is an important step toward addressing the issues raised by Rousseau. Their work has potential for advancing evidence-based practice in health care management. The text begins with research findings suggesting that health care executives make little use of evidence in decision making and that executives perceive existing evidence is inadequate to support decision making. The book continues with the authors sharing their experiences in the use of evidence in health care management. Kovner discusses the Montefiore Medical Center experience in New York. David Fine and Emily Garrison report on efforts to transform the culture at St. Luke's Episcopal Health System in Houston through the use of metrics and information gathering to support decisions. Richard D. Aquila shares his experience at Yale-New Haven Hospital in improving hospital performance through a coordinated use of evidence-based analysis and decision making in hospital operations. These three examples highlight the value that a health care organization can derive from using evidence, and they provide a strong counter argument to the reported conventional wisdom that adequate information is not available for health care management use.
The next section of the text provides a detailed discussion of evidence-based management and provides examples of the types of questions that might be addressed with this approach. The book offers a six-step approach for developing actionable evidence. These steps include: 1) framing the question behind the decision; 2) finding sources of information: 3) assessing the accuracy of the information; 4) assessing the applicability of information; 5) assessing the action ability of information; and 6) determining whether the information is adequate. …