OutBox

Evidence-Based Management

By Thomas G. Rundall

It would seem obvious that decision-making should be based on sound research and facts, but it's not.

Evidence-based management in health care organizations is as crucial as evidence-based medicine: the latter improves the quality of care and the former improves the quality of management decision-making. Instances of overuse, underuse and misuse of management tactics and strategies receive far less attention and are much more difficult to document than their clinical equivalents, but they also can harm people and organizations and inflict significant financial loss.

To promote and adopt EBM, managers have identified four key strategies.

Recognize and respond to the growing demand for accountability as a strategic issue. Today, effective decision-making about highly scrutinized issues, such as a merger, as well as decisions on less visible but important issues, such as implementing components of the chronic care model, recruiting and retaining personnel, and implementing information technology, have strategic importance. Leaders should make it clear that their decisions are based on the best evidence available—that is, they have anticipated the consequences of their decisions, demonstrated good stewardship of resources and acted to ensure their organization's viability by using the best information available to improve performance.

Establish organizational structures and processes for knowledge transfer. Knowledge management involves identifying, creating, representing and distributing knowledge for reuse, awareness and learning across the organization. Organizations can assign this responsibility to individuals or teams within the organization, which should keep the knowledge management environment "live" through frequent communication with managers, physicians, nurses and others.

Build a questioning organizational culture. By creating and sustaining a "questioning" culture, the use of EBM will follow. Strategies for building a questioning culture include encouraging managers to challenge the evidence base for important decisions, having managers participate in research "rounds" or journal clubs, and comparing the organization's performance with research findings from other organizations.

Build organizational research capabilities. Organizations need to train managers in evidence-informed decision-making and establish "linkage and exchange" relationships with universities, research centers, consulting firms and other knowledge brokers, and individual researchers. Another strategy for building research capabilities is to conduct in-house research on important issues, before and after these decisions are made. Managers who conduct their own studies, focus groups or market assessments have more knowledge management skills and are more supportive of EBM.

Successful EBM requires continual leadership by boards, executives, clinical staff and managers. In particular, board and executive leadership must focus attention on the intersection of the quality, efficiency, access and EBM agendas. This will reduce the quality gap and instill greater confidence in our health system. For more information, access the Informed Decisions Toolbox at http://toolbox.berkeley.edu.

Thomas G. Rundall, Ph.D., is executive associate dean and Henry J. Kaiser Professor of Organized Health Systems at the School of Public Health, Univ. of California, Berkeley. You can contact our guest author at trundall@berkeley.edu. Rundall also serves as co-director of the Center for Health Management Research, a program of the Health Research and Educational Trust (www.hret.org/hret/programs/chmr).

This article 1st appeared in the November 2007 issue of HHN Magazine.

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