Evidence-basedmanagement – healthcare
manager viewpointsAli Janati
Iranian Center of Excellence in Health Management,School of Management and Medical Informatics,Tabriz University of Medical Sciences, Tabriz, Iran
Edris HasanpoorDepartment of Healthcare Management,
Maragheh University of Medical Sciences, Maragheh, IranSakineh Hajebrahimi
Research Center for Evidence Based Medicine,Tabriz University of Medical Sciences, Tabriz, Iran, and
Homayoun Sadeghi-BazarganiRoad Traffic Injury Prevention Research Center,Tabriz University of Medical Sciences, Tabriz, Iran
AbstractPurpose – Hospital manager decisions can have a significant impact on service effectiveness and hospitalsuccess, so using an evidence-based approach can improve hospital management. The purpose of this paperis to identify evidence-based management (EBMgt) components and challenges. Consequently, the authorsprovide an improving evidence-based decision-making framework.Design/methodology/approach – A total of 45 semi-structured interviews were conducted in 2016.The authors also established three focus group discussions with health service managers. Data analysisfollowed deductive qualitative analysis guidelines.Findings – Four basic themes emerged from the interviews, including EBMgt evidence sources (includingsub-themes: scientific and research evidence, facts and information, political-social development plans,managers’ professional expertise and ethical-moral evidence); predictors (sub-themes: stakeholder valuesand expectations, functional behavior, knowledge, key competencies and skill, evidence sources, evidencelevels, uses and benefits and government programs); EBMgt barriers (sub-themes: managers’ personalcharacteristics, decision-making environment, training and research system and organizational issues); andevidence-based hospital management processes (sub-themes: asking, acquiring, appraising, aggregating,applying and assessing).Originality/value – Findings suggest that most participants have positive EBMgt attitudes. A fullevidence-based hospital manager is a person who uses all evidence sources in a six-step decision-makingprocess. EBMgt frameworks are a good tool to manage healthcare organizations. The authors found factorsaffecting hospital EBMgt and identified six evidence sources that healthcare managers can use in evidence-based decision-making processes.Keywords Hospital, Hospital managers, Evidence-based practice, Evidence-based management,Evidence-based decision makingPaper type Research paper
International Journal of HealthCare Quality AssuranceVol. 31 No. 5, 2018pp. 436-448© Emerald Publishing Limited0952-6862DOI 10.1108/IJHCQA-08-2017-0143
Received 8 May 2017Revised 5 September 2017Accepted 17 September 2017
The current issue and full text archive of this journal is available on Emerald Insight at:www.emeraldinsight.com/0952-6862.htm
This paper is based on an evaluation project supported by the Research Affairs Deputy at TabrizMedical Sciences University (TUOMS). The authors acknowledge the Iranian Center of Excellence inHealth Management team. The authors thank E. HassanZadeh, H. Gharayie and Y. MosaZadeh forhelping with data collection and all the interviewees for giving their experiences.
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IntroductionThere has been an intensive effort to develop new organization and administration models inthe last 20 years (Acton, 1998; Axelsson, 1998; Baba and HakemZadeh, 2012; Barends andBriner, 2014; Briner et al., 2009; Briner and Walshe, 2014). One model is evidence-basedmanagement (EBMgt) (Axelsson, 1998; Bullock et al., 2012; Guo, 2015; Jaana et al., 2013).Hospitals are among the main organizations in the community that provide medical careservices (Ford-Eickhoff et al., 2011). Shifting healthcare perspectives over the last two decadeshas complicated hospital management (Ford-Eickhoff et al., 2011). Consequently, complexhospital management, as a skill and specialty, has become an important and pivotal issue(Alexander et al., 2007; Ford-Eickhoff et al., 2011). Therefore, managers are forced to useevidence-based healthcare management (EBHCMgt) to be effective (Guo, 2015; Hewison, 2004;Liang et al., 2012; White et al., 2005). EBHCMgt improves organizational and managerialdecisions by bridging theory and practice gaps, which has a critical impact on hospitalperformance (Alexander et al., 2007; Axelsson, 1998; Guo, 2015; Hewison, 2004; Liang andHoward, 2011; Liang et al., 2012; Majdzadeh et al., 2012; White et al., 2005). EBMgt is rooted inevidence-based medicine (EBM) – a new approach to management practice that requireshealthcare managers to change (Axelsson, 1998; Guo, 2015; Walshe and Rundall, 2001). LikeEBM, EBMgt is a tool to respond to questions about a decision’s consequence (Pfeffer andSutton, 2007; White et al., 2005).
We live in an evidence-based everything era and that everything: medicine; nursing;healthcare management; decision making; and hospitals, have become information based(Acton, 1998; Liang et al., 2012). Hospital manager decisions have a significant impact onservice quality and hospital success (Guo, 2015). If healthcare managers do not pay attentionto evidence-based decision making (EBDM), then they will face problems such asdisorganization and useless work. Yet, recent studies show that only 15 percent of physiciandecisions are evidence based, so can physicians be hospital managers? (Rousseau et al., 2008;Walshe and Rundall, 2001). High-quality hospital management is believed to have a positiveimpact on mortality, staff well-being, employees’ efficiency, performance and productivity(Agarwal et al., 2016). Iranian hospitals continue to change into dynamic environments,partially owing to recent political and also regulatory evolution (Kiaei et al., 2015). Hospitalmanagement requires professional skills and hospital management – a specialized disciplinedemanding training and skills – cannot be exclusively acquired in the job. Most Iranianhospital administrators are physicians (Rabbani et al., 2015). Several management andmedicalinformatics schools in Iran educate students and produce chief executive officers. However,hospital managers are rarely employed in managerial positions. Low expertise inmanagement and weak direction are the main reasons why many important hospitalinitiatives fail (Rabbani et al., 2015). One primary step to promote EBDM is to identify thechallenges facing EBMgt. Recognizing specific EBMgt attitudes and perceived barriers canpromote new workplace-behaviors. Our purpose, therefore, was to determine Iranian hospitalEBMgt’s components and challenges.
Theoretical/conceptual framework: EBMgtEBMgt, an evolving discipline, originally borrowed from EBM, started in the early 1990s(Barends et al., 2015; Guo, 2015). Evidence-based is a term created in the 1990s inmedicine (Barends et al., 2014); nowadays its principles extend to various disciplinesincluding nursing, education, criminology, social work and public policy (Barends et al.,2015). Inspired by the EBM movement, Axelsson (1998) introduced an innovativeapproach, calling it EBMgt, which he advocated to mean that healthcare managers shouldlearn to search for and critically appraise evidence from management research as abasis for their practice. There are many standpoints regarding EBMgt that are inspiredand presented by management and organization specialists. Axelsson (1998), Walshe and
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Rundall (2001), Rousseau et al. (2008), Pfeffer and Sutton (2007), Briner et al. (2009),Barends et al. (2015) and Wright et al. (2016) investigated EBMgt, its applications andcomponent. According to the EBM pyramid, the literature presents different evidencelevels that can be used by managers and other healthcare professionals in their decision-making process. Evidence sources include: best available scientific research;organizational data; professional experience and judgment; and stakeholder values andconcerns (Barends et al., 2015; Hewison, 2004; Jaana et al., 2013; Liang and Howard, 2011;Liang et al., 2012). The EBMgt theoretical framework is shown in Figure 1, which includestwo phases.
The first phase is the EBDM cycle, which is implemented in six consecutive stages.The second phase is evidence sources to be considered when making decisions. Manyfactors play different but significant roles that affect EBMgt, including: facilitators; barriers;and predictors. Based on the literature, therefore, we divide EBMgt into three phases(Guo, 2015; Hyder et al., 2010; Liang et al., 2012; Majdzadeh et al., 2008).
First phase (1998-2005): introducing and offering: the EBMgt movement lasted from 1998to 2005. Throughout, writers began to formulate EBM and apply its principles to healthcaremanagement practice.
Second phase (2006-2012): publishing and production: it ran between 2006 and 2012.During this time, more scholarly EBMgt articles and books were produced.
Third phase (2013-future): adoption and utilization: it proceeded from 2013 and continues.Healthcare EBMgt been discussed for more than 16 years. Therefore, it seems important toconsider the challenges and factors affecting EBMgt in healthcare organization, especiallycomplex organizations like hospitals. Identifying challenges, based on the healthcaremanagers’ viewpoints, can assist hospital managers and researchers.
MethodsStudy design and sampleWe used qualitative methods to achieve our aims. Semi-structured interviews with45 participants were conducted in 2016. We also ran three focus group discussions (FGDs)with 27 health managers. Participants included policy makers and Ministry of Health andMedical Education (MoHME) managers, research managers and policy makers elsewhere,hospital managers, health policy, management and health research and experiencedadministrators. Participants’ characteristics are displayed in Table I. Iranian Center of
EBDM process
Sources of evidence Context
Facilitators, barriers and predictors affecting EBMgt in hospitals
Asking Acquiring Appraising Aggregating Applying Assessing
Organizational data, facts and
figures
Available scientific research
Professional experience and
judgment
Stakeholders’ values and concerns
Figure 1.EBMgt theoreticalframework (Center forEvidence-BasedManagement (CEBM))
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Excellence in Health Management staff sent a formal letter explaining the study to56 experts in seven provinces (Tehran, East Azerbaijan, West Azerbaijan, Qazvin, Ardabil,Yazd and Hamadan). A total of 45 agreed to be interviewed.
Data collectionThe FGDs involved researchers and healthcare managers, and in-depth interviews includedpolicy makers and managers. Before the interviews, top managers in each organizationidentified, named and defined change initiatives, which were underway. Nine participantsparticipated in each FGD. Interviews continued until data saturation was achieved. Bothinterviews and FGDs were conducted by one researcher and one note-taker. Interviews andFGDs lasted 60-90 minutes. Our research questions investigated manager viewpoints andbarriers to EBMgt:
RQ1. What evidence sources did managers consult in their decisions?
RQ2. What are the managers’ views about hospital EBMgt?
Provinces (n¼ 8) Organizations (n¼ 16) Position Number
East Azerbaijan ICEHM Expert in management sciences, associate professor inhealth policy, economics and management, managerialexperience, senior manager in ICEHM
9
East Azerbaijan Iranian EBM Centre ofExcellence
Senior manager in Iranian EBM Centre of Excellence,expert in systematic reviews and knowledgetranslation
4
Tehran MoHME Office director in the hospital management and clinicalservice excellence, deputy of MoHME in the field ofplanning, senior manager in MoHME
3
West Azerbaijan,Qazvin and Tabriz
Healthcareorganizations
Hospital manager, faculty members in health servicesmanagement, associate professor in healthcaremanagement
6
East Azerbaijan Tabriz University ofMedical Sciences
Associate professor in health services managementand health information management, managerialexperience in hospital
4
Tehran Tehran University ofMedical Sciences
Associate professor in health policy, economics andmanagement; managerial experience
4
Yazd Yazd University ofMedical Sciences
Associate professor in health services management 1
Hamadan Hamadan Universityof Medical Sciences
Associate professor in health services management,managerial experience in health sector
3
West Azerbaijan Uremia University ofMedical Sciences
Managerial experience in health sector and associateprofessor in health services management
1
Tehran Iran University ofMedical Sciences
Managerial experience in hospital, senior manager infaculty of health management, faculty members inhealth services management
5
Ardabil Ardabil University ofMedical Sciences
Professor, management science, managerial experience 1
East Azerbaijan University of Tabriz Associate professor of management science(organizational policy making)
1
Tehran University of Tehran Professor of management science, managerialexperience
1
Tehran Tarbiat ModaresUniversity
Professor of management science, managerialexperience
1
Tehran Allameh Tabataba’iUniversity (ATU)
Professor of management science, managerialexperience
1
Total 45Table I.
Research participants
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RQ3. What contextual barriers do managers perceive when using EBMgt?
RQ4. What are the managers’ views about EBMgt components?
Interviews included questions on Iranian hospital EBMgt challenges and componentsand its implementation procedures. We used the Tehran University of MedicalSciences knowledge translation model to design in-depth interviews and FGDsguidelines (Majdzadeh et al., 2008). A semi-structured questionnaire was developed forboth FGDs and in-depth interviews, which included: EBMgt’s meaning, features, benefits,predictors, challenges and outcomes and factors influencing EBMgt, organizationalprocesses involved in implementation, what has and has not worked well andwhat is needed for the future. Open questions were used to encourage participants toelaborate their EBMgt experiences. We used a questionnaire to collect demographic data.Other questions asked about evidence sources, current knowledge and participants’attitudes to EBMgt.
Analytical approachOur qualitative analysis, based on previous knowledge about EBMgt, aimed to investigatechallenges to better understand hospital EBMgt. We applied deductive content analysiswhen coding interview data, using the theoretical framework dimensions (discussed earlier).All transcripts were read. Challenges and components were coded as themes. Homogeneousthemes were composed, and categories created. To achieve triangulation, a weekly researchmeeting was held to discuss interview status and feedback, and to seek consensus aboutany interview coding issues. During the coding process, researchers made an initial passthrough the transcripts followed by coding clarification and assignment criteria. Next, theyreevaluated code assignments and made corrections based on the definitions that resultedfrom discussion in research meetings. All documented in-depth interviews and FGDs werereviewed independently by two researchers to ensure reliability. When there wasdisagreement, the group made the final decision.
Ethical considerationsThe project proposal was approved by the Tabriz University of Medical Sciences ethicalcommittee (project code: TBZMED.REC.1395.497). After the study’s objectives had beenexplained, participants’ oral consent was obtained at each session.
ResultsA total of 45 interviews (27 men) were administered between June and November 2016).Mean age was 39.4 (SD¼ 9.34) years. Participants’ average work experience was 11.1(SD¼ 8.47) years (Table II). Of them, 29 participants had PhDs.
As Table III indicates, most respondents based their management decisions on: literature(91.12 percent); knowledge acquired through formal education (86.67 percent); scientificresearch (75.55 percent); personal judgment (71.12 percent); and advice from colleagues(60+ percent). Only a few participants said that they based their decisions on trial and error(13.34 percent). Results showed that most participants were familiar with online databases.All were familiar with Google Scholar and 90 percent knew other databases includingPubMed/Medline, Web of Science, SID and Magiran. Only 17.18 percent used Cochrane. Ourresults show that most participants were not familiar with research terms like: controlledstudy (22.23 percent); confidence intervals (20 percent); sensitivity (28.89 percent);generalizability (28.89 percent); bias (15.55 percent); and systematic reviews (26.67 percent).A total of 91 percent had conducted scientific research. Almost all believed in ethicalevidence. Only 26.67 percent read a research article every day. Table IV shows the main
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themes, sub-themes and final codes for each EBMgt dimension: EBMgt evidence sources,predictors and barriers; and evidence-based hospital management (EBHMgt) processes.According to the final codes we extracted, evidence sources were divided into six categories:scientific and research evidence; hospital facts and information; political-social developmentplans; professional expertise; ethical-moral evidence (EME); and stakeholder values andexpectations. These evidence sources determined administrators’ management domain. Anevidence-based hospital manager is someone who has full control over all evidence sources.
The main predictors we identified were: stakeholder values and expectations; functionalbehavior; knowledge; key competencies and skill; evidence levels and use; benefits andprograms, which were closely related to other main themes. These predictors determinedEBMgt’s theoretical framework (Table IV ). The EBMgt barriers were categorized into thefollowing areas: barriers related to managers’ characteristics; decision-making environment;training and research system; and organizational barriers. To understand the barriers, wedescribed the categories in more detail (Table IV ). Quotations and their interpretationconfirmed that EBHMgt was like the EBDM process. Our results show that EBHMgtcontains six stages: asking; acquiring; appraising; aggregating; applying; and assessing.Results indicate that at the beginning, the practical issue or problem must be translated intoan answerable question. Then, evidence is searched systematically. In the third phase,evidence should be appraised using appropriate tools. Afterward, hospital managers shouldaggregate the evidence and decide using the best evidence. At the end, decision outcomesmust be evaluated.
Demographics (n¼ 45)Frequency %
Qualitative variablesGender (percentage)Male 27 60.00Female 18 40.00
Current occupation group (percentage)Managers 10 46.70Faculty members 21 22.20Both 14 31.10
Highest level of education (percentage)Masters 2 4.40PhD 29 64.40MD 7 15.60MD, PhD 5 11.11MD, Specialists 2 4.40
Main expertise and skill (percentage)Strategic planning 11 20.00Change management 7 15.60Process improvement 5 11.10HRM 11 20.00Quality management 2 4.40Policy making 4 8.90Financing 5 11.10Accreditation 2 8.90
Minimum Maximum Mean SD
Quantitative variablesAverage age (years) 28 70 39.40 9.34Average work experience (years) 1 39 11.11 8.47Average healthcare management experience (years) 0 31 5.74 6.48
Table II.Interviewees
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DiscussionWe identified the EBMgt barriers evidence sources as EBMgt predictors and EBHMgt,looking from researchers’ and managers’ perspectives. Hyder et al. (2010) identified thechallenges and strategies when using knowledge in developing countries. Inappropriate
Items Frequency Agree %
Decision makingTrial-error 6 13.34Intuition-insight 10 22.23Personal judgment 32 71.12Acquired knowledge 39 86.67Consult with internal colleagues 30 66.67Consult with external colleagues 28 62.22Management literature 41 91.12Internet 22 48.89Scientific research 34 75.55
Familiarity with online databasesBusiness Source Premier from EBSCO 9 20.00Science Direct from Elsevier 18 40.00PsycINFO 10 22.23Inter Science 9 20.00ProQuest 29 64.45Cochrane 8 17.18CINAHL 9 20.00Springer 28 62.23Ovid 25 55.55PubMed/Medline 42 93.34Scopus 32 71.12Web of Science 41 91.12Embase 9 20.00Emerald 19 42.23SID (Iranian) 42 93.34Magiran (Iranian) 44 97.78Google Scholar 45 100
Familiarity with research termsControlled study 10 22.23Observational study 23 51.11Case study 25 55.55Confidence interval 9 20.00Statistical significance 33 73.34Internal validity 20 44.45Reliability 20 44.45Sensitivity 13 28.89Generalizability 13 28.89Bias 7 15.55Correlation 18 40.00Systematic reviews 12 26.67Sampling 18 40.00Do you have experience conducting scientific research? 41 91.12Was there special attention given to scientific research in your formal education? 29 64.45Do you believe ethical evidence? 44 97.78Would you like healthcare management to be evidence-based? 44 97.78Do you regularly search databases online? (once a week) 35 77.78Do you regularly read research articles? (per day) 12 26.67Are you familiar with health management journals? (more than 20 journals) 20 44.45
Table III.Healthcare managerviewpoints
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Main themes Sub-themes Final codes
Evidence sources in EBMgt Scientific and ResearchEvidence (SRE)
Academic journalsScientific evidenceResearch evidenceObservational evidence
Facts and information ofhospital
Hospital information systemManagement dashboardInternal evidenceData and factsSupportive team of hospitalQuestionnaires and checklists
Political-socialdevelopment plans
Government lawsPolitical-social programsPrograms of MOH
Managers’ professionalexpertise
ExperienceSkillProfession
Ethical-moral evidence(EME)
Religious evidenceEthical evidenceMoral evidence
Stakeholder values andexpectations
ValuesExpectations and concernsStakeholders
EBMgt predictors Functional behavior Attitude toward the EBMgtIntention to use EBMgt
Knowledge ManagerialOrganizationalHealthcare
Key competencies and skill Key competencies and skillEvidence sources Internal evidence
External evidenceEvidence levels Levels of evidenceUses of evidence Uses of evidenceBenefits Efficiency
EffectivenessQuality
Government programs RegulationsPoliciesPlans
EBMgt barriers Managers’ characteristics Absent criteria for selecting decision makersFew reward and incentive mechanismsInsufficient knowledge and negative attitudetoward EBMgtNon-executive administrationLacking administrative and financial skills
Decision-makingenvironment
Organizational valueRestricted perspectiveSituation of policy environmentLack of coordination
Training and researchsystem
Lack of skill and competenciesLack of communication with the scientific andresearch institutionsLack of specialization in hospital managementLack of evidence-based educations
(continued )Table IV.Synthesis
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communication, heterogeneous aims and researchers/decision makers’ languages, policymakers’ limited professional skill, resource restrictions, organizational culture andparliamentary and budgetary policies were identified as the main barriers. According toMajdzadeh et al. (2012), Iranian health system EBDM barriers are categorized into: decisionmakers’ characteristics; decision-making environment; and research system.
Barends et al. (2015) investigated managers’ attitudes in Belgium, the Netherlands andthe USA. Most respondents (60 percent) reported that they had insufficient time to readresearch articles and they regarded time limitation to be the main barrier. Also, notunderstanding scientific research (56 percent) and research ambiguity (42 percent) were themain barriers. Other barriers to managers using scientific research were organizationalculture. The main barriers we identified were consistent with systematic reviews inmedicine, nursing and other studies (Guo, 2015; Kajermo et al., 2010; Patelarou et al., 2013;Solomons and Spross, 2011; van Dijk et al., 2010).
According to principles, evidence must be: scientific; organizational; experiential; andstakeholder (Barends et al., 2014). In our study, this classification was changed. Intervieweessuggested that evidence sources were categorized into six domains. Evidence-basedmanagers are like spiders, i.e. they dominate all six evidence sources. As shown in Figure 2,we identified EBMgt evidence sources and management domains. Depending on theproblem, using the EBHMgt process, managers will select the best available evidence andsources. Participants believed that political-social development plans and EME can beuseful evidence sources in the decision-making process.
A fully evidence-based hospital manager is a person who uses evidence sources in a six-step decision-making process. Hospital managers should use the best evidence based on theproblem and population. Those who use only one evidence source cannot make decisionsproperly. As shown in Figure 2, depending on the source, managers may decide on one orseveral areas in all organizational decisions. Hospital EBMgt predictors can provideinformation on the gaps between knowledge and practice to improve decision-makingprocesses (Guo, 2015). The main predictors in our investigation were: stakeholder valuesand expectations; functional behavior; knowledge; key competencies and skill; evidencesources and levels; evidence use and benefits; and government programs. Although our
Main themes Sub-themes Final codes
Organizational barriers Excessive bureaucracy and inappropriatestructureOrganizational cultureLimitation of financial and human recoursesLack of timeLack of teamwork
Evidence-based hospitalmanagement process
Asking QuestioningTranslatingProblems
Acquiring SearchingFindingSource of evidence
Appraising Validity and accuracyJudgingAppraising
Aggregating ArrangingApplying Decision-making process
ImplementationAssessing EvaluationTable IV.
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findings agree with Guo (2015), Barends et al. (2015) did not find a significant relationshipbetween education, experience and attitude toward EBMgt. Liang et al. (2013) conducted amixed-method study in Australian public hospitals and showed that evidence-informeddecision making required certain skills, knowledge and attitudes. A positive attitude towardEBMgt, adequate and appropriate knowledge from hospital and management and EBDMskill are EBMgt predictors. Almost all participants (n¼ 44) believed that healthcaremanagement can be evidence based and had positive attitude toward EBMgt.
The EBHMgt framework is a useful tool to better manage all healthcare organizations. Inthis framework, predictors, barriers, evidence sources and process EBHMgt are explained andidentified. It is essential to understand the context and interaction between these factors. In thatcontext, factors such as predictors, barriers and training organizations, and research institutescan improve decision making. In the Liang et al. (2012) study, framework determinants canimprove the evidence in managerial decision making. We suggest that evidence-based decisionmaking is important when making management decisions. In 2013, the elected Moderationand Development Party began to change the health sector, i.e. the Health Sector Evolution Planand Health Transformation Plan were designed by the MoHME to achieve universal andcomprehensive health services coverage. However, policy makers should not fail to engageevidence-based professions (Moradi-Lakeh and Vosoogh-Moghaddam, 2015). To create andimplement evidence-based evolutions, we need to teach evidence-based healthcare managers toapply their professional and expertise (Goodman et al., 2014; Niedźwiedzka, 2003). To adopt
EBHMgt Process
Context
5
1. Scientific and ResearchEvidence (SRE)
2. Facts and informationof hospital
3. Political-socialdevelopment plans
4. Managers professionalexpertise
5. Ethical-Moral Evidence(EME)
6. Values and expectationsof all stakeholders
Data and fact-based managers
Ethics-oriented
managers
Sources of evidence and management zones
Asking Acquiring Appraising Aggregating Applying Assessing
Trainingorganizationsand research
institutes
Predictors Barriers
Shareholder-oriented
managers
Expertise-oriented
managers
Plan-based
managers
Scienti
fic-
orien
tedman
agers
Figure 2.Evidence-based
hospital management
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and use EBMgt, hospital leaders need to promote a culture that helps managers to dedicatetime to consult scientific evidence. Staff in educational institutions need to focus on improvingEBMgt skills that are needed to find, read, evaluate and apply scientific evidence. Universityleaders need to train academics about methods needed to critically appraise and summarize thebest available evidence on a topic relevant to best practice.
ConclusionOur study suggests that most participants have positive EBMgt attitudes and that mostbelieve that using EBMgt can improve management decision making. EBHMgt can improvemanagement decisions and service delivery, effectiveness and efficiency. Since EBMgt is anemerging approach, its practice among hospital managers has been limited. Several factorsexist at organizational and personal levels, which play different and considerable roles.We know that many healthcare managers lack EBMgt skills. Thus, they need to instigateEBMgt through training organizations and research institutes. Our framework helpshospital managers to pursue the multiple evidence sources in knowledge utilizationprocesses. Using six evidence sources, managers recognize the best available evidence formanagement decisions and in an evidence-based decision-making process to make the bestdecision. To increase EBMgt benefits and use in hospitals, training organization andresearch institute staff must involve hospital managers to set research programs and toguide and facilitate evidence interpretation.
References
Acton, M. (1998), “Evidence-based everything: some implications for community care”, Journal ofIntegrated Care, Vol. 6 No. 5, pp. 189-192.
Agarwal, R., Green, R., Agarwal, N. and Randhawa, K. (2016), “Benchmarking management practices inAustralian public healthcare”, Journal of Health Organization and Management, Vol. 30 No. 1,pp. 31-56.
Alexander, J., Hearld, L., Jiang, H. and Fraser, I. (2007), “Increasing the relevance of research to healthcare managers: hospital CEO imperatives for improving quality and lowering costs”, HealthCare Management Review, Vol. 30 No. 2, pp. 150-159.
Axelsson, R. (1998), “Towards an evidence based health care management”, The International Journalof Health Planning and Management, Vol. 13 No. 4, pp. 307-317.
Baba, V. and HakemZadeh, F. (2012), “Toward a theory of evidence based decision making”,Management Decision, Vol. 50 No. 5, pp. 832-867.
Barends, E. and Briner, R. (2014), “Teaching evidence-based practice: lessons from the pioneers aninterview with Amanda Burls and Gordon Guyatt”, Academy of Management Learning andEducation, Vol. 13 No. 3, pp. 476-483.
Barends, E., Rousseau, D. and Briner, R. (2014), Evidence-Based Management: The Basic Principles, VUUniversity Press, Amsterdam.
Barends, E., Villenueva, J., Briner, R. and ten Have, S. (2015), “Managers’ attitudes and perceivedbarriers to evidence-based management an international survey”, in Barends, E.G.R. (Ed.),In Search of Evidence, VU University Press, Amsterdam, pp. 143-179.
Briner, R. and Walshe, N. (2014), “From passively received wisdom to actively constructed knowledge:Teaching systematic review skills as a foundation of evidence-based management”, Academy ofManagement Learning and Education, Vol. 13 No. 3, pp. 415-432.
Briner, R., Denyer, D. and Rousseau, D. (2009), “Evidence-based management: concept cleanup time?”,The Academy of Management Perspectives, Vol. 23 No. 4, pp. 19-32.
446
IJHCQA31,5
Bullock, A., Morris, Z. and Atwell, C. (2012), “Collaboration between health services managers andresearchers: making a difference?”, Journal of Health Services Research and Policy, Vol. 17 No. 2,pp. 2-10.
Ford-Eickhoff, K., Plowman, D. and McDaniel, R. Jr (2011), “Hospital boards and hospital strategicfocus: the impact of board involvement in strategic decision making”, Health Care ManagementReview, Vol. 36 No. 2, pp. 145-154.
Goodman, J., Gary, M. and Wood, R. (2014), “Bibliographic search training for evidence-basedmanagement education: a review of relevant literatures”, Academy of Management Learningand Education, Vol. 13 No. 3, pp. 322-353.
Guo, R. (2015), Prediction of Intention to Use Evidence-Based Management Among HealthcareAdministrators in the United States, Central Michigan University, ProQuest LLC, Michigan, MI.
Hewison, A. (2004), “Evidence-based management in the NHS: is it possible?”, Journal of HealthOrganization and Management, Vol. 18 No. 5, pp. 336-348.
Hyder, A., Corluka, A., Winch, P., El-Shinnawy, A., Ghassany, H., Malekafzali, H. and Ghaffar, A.(2010), “National policy-makers speak out: are researchers giving them what they need?”, HealthPolicy and Planning, Vol. 26 No. 1, pp. 73-82.
Jaana, M., Vartak, S. and Ward, M. (2013), “Evidence-based health care management: what is theresearch evidence available for health care managers?”, Evaluation and the Health Professions,Vol. 37 No. 3, pp. 314-334.
Kajermo, K., Boström, A., Thompson, D., Hutchinson, A., Estabrooks, C. and Wallin, L. (2010), “TheBARRIERS scale – the barriers to research utilization scale: a systematic review”,Implementation Science, Vol. 5 No. 1, pp. 1-22.
Kiaei, M., Moradi, R., Hasanpoor, E., Mohammadi, M., Taheri, A. and Ahmadzadeh, M. (2015), “Hospitalmanagers’ perception of recent health care reform in teaching hospitals of Qazvin, Iran”,Biotechnology and Health Sciences, Vol. 2 No. 4, pp. 6-17.
Liang, Z. and Howard, P. (2011), “Evidence-informed managerial decision-making: what evidencecounts?: (Part two)”, Asia Pacific Journal of Health Management, Vol. 6 No. 2, pp. 12-32.
Liang, Z., Howard, P.F., Leggat, S.G. and Murphy, G. (2012), “A framework to improve evidence-informed decision-making in health service management”, Australian Health Review, Vol. 36No. 3, pp. 284-289.
Liang, Z., Leggat, S., Howard, P. and Koh, L. (2013), “What makes a hospital manager competent at themiddle and senior levels?”, Australian Health Review, Vol. 37 No. 5, pp. 566-573.
Majdzadeh, R., Sadighi, J., Nejat, S., Mahani, A. and Gholami, J. (2008), “Knowledge translation forresearch utilization: design of a knowledge translation model at Tehran University of MedicalSciences”, Journal of Continuing Education in the Health Professions, Vol. 28 No. 4, pp. 270-277.
Majdzadeh, R., Yazdizadeh, B., Nedjat, S., Gholami, J. and Ahghari, S. (2012), “Strengthening evidence-based decision-making: is it possible without improving health system stewardship?”, HealthPolicy and Planning, Vol. 27 No. 6, pp. 499-504.
Moradi-Lakeh, M. and Vosoogh-Moghaddam, A. (2015), “Health Sector Evolution Plan in Iran; equityand sustainability concerns”, International Journal of Health Policy and Management, Vol. 4No. 10, pp. 637-640.
Niedźwiedzka, B. (2003), “Barriers to evidence-based decision making among Polish healthcaremanagers”, Health Services Management Research, Vol. 16 No. 2, pp. 106-115.
Patelarou, A., Patelarou, E., Brokalaki, H., Dafermos, V., Thiel, L., Melas, C. and Koukia, E. (2013),“Current evidence on the attitudes, knowledge and perceptions of nurses regarding evidence-based practice implementation in European community settings: a systematic review”, Journalof Community Health Nursing, Vol. 30 No. 4, pp. 230-244.
Pfeffer, J. and Sutton, R.I. (2007), “Suppose we took evidence-based management seriously: implicationsfor reading and writing management”, Academy of Management Learning and Education, Vol. 6No. 1, pp. 153-155.
447
Evidence-based
management
Rabbani, F., Hashmani, F., Mukhi, A., Gul, X., Pradhan, N., Hatcher, P. and Abbas, F. (2015), “Hospitalmanagement training for the Eastern Mediterranean region: time for a change?”, Journal ofHealth Organization and Management, Vol. 29 No. 7, pp. 965-972.
Rousseau, D., Manning, J. and Denyer, D. (2008), “Evidence in management and organizational science:assembling the field’s full weight of scientific knowledge through syntheses”, The Academy ofManagement Annals, Vol. 2 No. 1, pp. 475-515.
Solomons, N. and Spross, J. (2011), “Evidence‐based practice barriers and facilitators from a continuousquality improvement perspective: an integrative review”, Journal of Nursing Management,Vol. 19 No. 1, pp. 109-120.
van Dijk, N., Hooft, L. and Wieringa-de Waard, M. (2010), “What are the barriers to residents’ practicingevidence-based medicine? A systematic review”, Academic Medicine, Vol. 85 No. 7, pp. 1163-1170.
Walshe, K. and Rundall, T. (2001), “Evidence‐based management: from theory to practice in healthcare”, Milbank Quarterly, Vol. 79 No. 3, pp. 429-457.
White, K., Clement, D. and Nayar, P. (2005), “Evidence-based healthcare management competencyevaluation: alumni perceptions”, The Journal of Health Administration Education, Vol. 23 No. 4,pp. 335-349.
Wright, A., Middleton, S., Greenfield, G., Williams, J. and Brazil, V. (2016), “Strategies for teachingevidence-based management: what management educators can learn from medicine”, Journal ofManagement Education, Vol. 40 No. 2, pp. 194-219.
Corresponding authorEdris Hasanpoor can be contacted at: [email protected]
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