Evidence-Based Management

A Practical Guide for Health Professionals

Rosemary Stewart

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315348100
• Edition: 1
• Topic: Medicina
• Subtopic: Salud pública, administración y atención

The NHS pension scheme is the largest in Europe. This guide explains how it works and how to maximize its benefits and avoid its pitfalls. The book covers: recent changes to the scheme including new provisions for early retirement; personal pensions, financial planning and investment options; advice on preparing for retirement and working after retirement; state benefits; and health and leisure in retirement. It is written for all NHS staff and should be of particular value to GPs and salaried doctors.

1

An overview of evidence-based management

Evidence-based management is primarily an attitude of mind.

What is evidence-based management? Why should managers practise it? These are the questions that a first chapter should answer. It will also look at what can be learnt from the development of evidence-based medicine, and at what can be done to overcome the obstacles to practising evidence-based management.

Managers would benefit from practising evidence-based management because:

●it is a way of overcoming some common management failings

●the rapid changes affecting organisations reduce the value of experience as a guide to managing

●there is a revolution in the importance and accessibility of information

●the development of evidence-based medicine has shown the way.

What is evidence-based management?

There are two answers to this question. For the first, the widely used definition of evidence-based medicine:

The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.¹

can be modified to:

The conscientious, explicit and judicious use of current best evidence in making decisions.

The words ‘conscientious’, ‘explicit’ and ‘judicious’ in the definition are each important for good practice. ‘Conscientious’ means that managers will consider what evidence is relevant for a decision and, where necessary, will search for it. ‘Explicit’ means that the nature of the evidence on which a decision is to be based will be examined and not taken for granted. ‘Judicious’ means a careful examination of the nature and reliability of the evidence.

Many decisions will be routine ones that are taken on the basis of experience without any search for more information. Evidence-based management is relevant to the more important and unusual decisions, but as in medicine, you should check periodically to see that your habitual experience-based decisions are still relevant.

The first answer to the question: ‘What is evidence-based management?’ is too narrow and too academic to be of much help to the manager. A broader answer is also needed. This is given at the head of the chapter: ‘Evidence-based management is primarily an attitude of mind’. This shows itself by a questioning approach, which asks the following questions.

●How should we assess performance?

●What questions should we be asking ourselves about our performance? ‘Our’ may be a team, or any organisational unit, large or small.

●What kind of information do we need to answer each question?

●Where and how can we find it?

●What is the most reliable way of getting it?

●What can we realistically do to improve our performance?

●How should we monitor our performance?

●Is the information that we are using good evidence? What may make it inaccurate?

●Is it important to try and improve the quality of the evidence? Have we the time and resources to do so? If not, what allowances should we make for possible inaccuracies?

Many aspects of evidence-based management are part of good management, and are called planning, organising, monitoring and implementing, but they may be neglected, or poorly done. An emphasis on evidence-based management can be used to give a new focus to tackle these common management failings – failings that now matter more because experience is less often a good guide than in the past.

The idea of evidence-based management can be applied in any organisation, but it is easier to do so in the public sector because information can be shared more freely than in the private sector. This difference is illustrated in a US article about evidence-based management in healthcare² which argues the need for evidence-based management cooperatives to overcome the reluctance to share information.

Lessons from evidence-based medicine?

Many readers from the health services will be familiar with the term ‘evidence-based medicine’, and even know the common abbreviation EBM – pity it has been appropriated and so cannot be used for evidence-based management! Managers from other sectors may not. The simplest explanation of evidence-based medicine is that it is a way of helping, and persuading, clinicians to use the most up-to-date evidence on the best way to treat a particular disease. To be used, clinicians must know about it, so a variety of ways of telling them have been developed. There is the Cochrane Centre, which provides up-to-date summaries of the latest evidence; there is a journal, Evidence-based Medicine. Guidelines or protocols are also produced by different medical groups, usually after considerable discussion and consultation, particularly for common diseases where there is wide agreement about what is the best evidence. These may give very detailed prescriptions for how to treat a particular disease.

A lot of effort has been spent in the UK and the US, and other countries, from the 1990s onwards to encourage the practice of evidence-based medicine. As a 2001 doctoral thesis comparing US/UK initiatives in this area says:

Evidence-Based Medicine (EBM) has for the past several years been viewed by many politicians, managers and clinicians as the magic key to changing clinical practice in the US and UK.³

The enthusiasm from policy makers arose not just from the desire that doctors should practise evidence-based medicine, but also in the expectation, especially in the US, that doing so could make for economies to help offset the alarming rise in the costs of using new medical discoveries.

There has been a lot of enthusiastic support for the idea of EBM, but also considerable controversy. This has focused on the relative importance of evidence and experience, on what is meant by ‘evidence’⁴ and, particularly in the US, on a concern that it was finance driven. Specific concerns are:

●how generally applicable is the research? Is it relevant to different kinds of patients and to different situations?

●the relative importance of research results compared with experience in deciding on what treatment is appropriate for a particular patient

●that evidence-based medicine can encourage a false sense of scientific accuracy and objectivity, when medicine is still an art where experience is important

●that protocols based on the research may be used too rigidly to allocate resources and used by nurses in circumstances where more medical experience is required to assess whether the protocol is appropriate for the particular patient.

Researchers who did four in-depth case studies of clinical changes in one region of the NHS concluded that medical evidence is much less clear-cut than discussions of evidence-based medicine often suggest:

Our research suggests that scientific evidence is not a clear, accepted and bounded source. There is no such entity as ‘the body of evidence’…. Much of what is called evidence is, in fact, a contested domain, constituted in the debates and controversies of opposing viewpoints in search of ever more compelling arguments.⁵

The researchers emphasise that evidence does not speak for itself, but must always be seen in context, which includes the local ideas, practices and attitudes of professionals. Both in management and in medicine there is a need to be precise in talking about the evidence being considered: what specifically is it evidence of?

The main lesson that those who want to practise evidence-based management should learn from the experience of evidence-based medicine is that evidence is socially determined, that is, it can only be used as evidence if other people accept it as such. A powerful top manager in a large technical company used to say when he disagreed with arguments being put forward: ‘My facts are better than yours’. Another lesson is that one should not have too optimistic a view about the nature of evidence, thinking of it as hard facts, but rather as the best that we can find for our purposes.

Comparing evidence-based medicine and evidence-based management

There are major differences between the problems faced by clinicians and managers, but the similarities make some of the lessons from evidence-based medicine relevant to evidence-based management.

Similarities in the practice of evidence-based medicine and the practice of evidence-based management

●The need for evidence-based practice has become much greater for both clinicians and managers because of the rapidity of change affecting their work. It has also become greater because doctors and managers in the public sector, particularly chief executives, are held more accountable for their actions than in the past.

●New developments in medicine and in management, and changes in the political, social, economic and technical environment, mean learning about their implications.

●Clinicians and managers face a similar difficulty in the time pressure to take decisions; both have to decide when a decision requires more thoug...