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Evidence-Based Practice

AUPHA Annual Meeting, June 20, 2013, Monterey. Evidence-Based Practice. If doctors can do it managers can do it?. Evidence? outcome of scientific research, organizational facts & data, benchmarking, best practices, collective experience, personal experience, intuition.

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Evidence-Based Practice

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  1. AUPHA Annual Meeting, June 20, 2013, Monterey Evidence-Based Practice If doctors can do it managers can do it?

  2. Evidence? outcome of scientific research, organizational facts & data, benchmarking, best practices, collective experience, personal experience, intuition

  3. All managers base their decisions on ‘evidence’

  4. However ...

  5. Many managers pay little or no attention to the quality of the evidence they base their decisions on

  6. Trust me, 20 years of management experience

  7. Teach managers how to critically evaluate the validity, and generalizability of the evidence and help them find ‘the best available’ evidence

  8. Evidence-based decision

  9. Proof of concept What is the added value of evidence- based practice for managers within the field of hospital care?

  10. Evidence based pilot Teaching Hospital - 6 managers University Hospital - 4 managers

  11. Evidence based pilot Phase 1: Training managers in the principles of EBP Phase 2: Examination of the current decision making processes that managers are using Phase 3: Evaluation of 4 completed projects from an EB perspective (retrospective) Phase 4: Making EB recommendations for 4 new projects (prospective) Phase 5: Evaluation

  12. Some preliminary results

  13. Decision making process

  14. Decision making process • Focus on procedures instead of evidence • Internal politics and power struggles • No critical appraisal of the evidence at hand • Relying on anecdotal evidence (workshops, best practices, popular management books, consultants) • One option (sometimes two) • Bias: Outcome, Halo, Confirmation, etc.

  15. Post mortem analysis

  16. Evidence-based perspective NOT: Did we made the right decision? BUT: Is there evidence from scientific research to support (or call into question) the approach taken? Best availableevidence?

  17. Post mortem: leadership training

  18. leadership training: dm process • No problem definition • No organizational evidence consulted • Selection of training companies based on experience, recommendation or reputation • No explicit selection criteria / procedure • ‘Best’ presentation has won: one size fits all

  19. leadership training: scientific evidence • 15 meta analyses, 5 relevant • 37 (‘systematic’) reviews, 2 relevant • Lots of relevant primarystudies

  20. leadership training: scientific evidence • Long history (30 yrs): moderate effect sizes • Senior & middle managers tend to benefit more than managers at the supervisory level • Effect on ‘poor’ leaders is limited. • Leadership trainings that focus on interpersonal / social skills show higher effect sizes than those based on a specific leadership ‘model’

  21. Reactions Whoknew? Denial Anger Bargaining Acceptance

  22. Prospective / EB recommendations

  23. Questions / projects • 360 degree feedback • Financial incentives • Lean Six Sigma • Hand Hygiene • Goal setting • Value Based Health Care • Downsizing

  24. Evidence-based perspective NOT: What works? BUT: What are, given the target group, the problem and the context involved, the main factors determining the success or failure of the project that need to be taken into account? Best availablescientificevidence?

  25. Prospective: Multi Source Feedback

  26. Multi Source Feedback: background • IFMS: based on multi source feedback • Regulating bodies and insurance companies (KPI’s – prices/ revenue) • Based on CANMEDS, no standard method • New market: consulting firms

  27. Process • Scoping session: inventory of the aspects relevant to the question • Session with leading academic • Search in relevant databases • Critical Appraisal • Summary / research synthesis • Recommendations / guidelines

  28. Multi Source Feedback: scientific evidence • 223 primary studies on MSF, 42 relevant • 6 meta analyses or systematic reviews on MSF, 3 relevant • 18 meta analyses or systematic reviews on • ‘feedback’ or ‘performance appraisal’, 5 relevant

  29. Multi Source Feedback: main factors Raterreliablity(patients, nurses, colleagues) Type andnumber of raters Selection of raters Type of response scale Organizational culture Way of the delivery of the feedback Perceivedproceduraljustice Content of the feedback (neg vs pos) Development vsperfomanceappraisal Interpretation of the feedback Feedback orientation of the ratee Personality of the ratee

  30. Reactions Whoknew? Wow! Great! Good stuff! Relevant!

  31. Lessons learnedI • New approach • Recalibrates the power dynamics (accountability!) • The profit is in the process • Different (better?) decisions were made • Doctors love it!

  32. Lessons learnedII • Hard for individual managers • It starts with the senior management team • It’s all about accountability • Support system • EBP > Planning & Control

  33. One day, maybe … Chief Evidence Officer

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