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Evidence-Base Practice

Evidence-Base Practice. Evidence-based practice? D ecisions should be based on a combination of critical thinking and the ‘best available evidence‘. . Evidence = Various types of information

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Evidence-Base Practice

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  1. Evidence-Base Practice

  2. Evidence-based practice? Decisions should be based on a combination of critical thinking and the ‘best available evidence‘.

  3. Evidence = Various types of information outcome of scientific research, organizational facts & data, benchmarking, best practices, collective experience, personal experience, intuition

  4. All managers base their decisions on ‘evidence’

  5. However ...

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

  7. Trust me, 20 years of management experience

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

  9. Best available evidence • Experiential evidence: the professional insight, understanding, and expertise of practitioners • Organizational evidence; data, facts and figures, business intelligence, and benchmarks • Scientific evidence: outcome from scientific research published in peer reviewed journals • Organizational values and stakeholders’ concerns

  10. Evidence based decision • Best available organizational evidence • Best available experiential evidence • Decision making process • Best available scientific evidence • Organizational values and stakeholders’ concerns

  11. Evidence based decision • Best available organizational evidence • Best available experiential evidence • Decision making process • Best available scientific evidence diagnosis intervention • Organizational values and stakeholders’ concerns

  12. Evidence based decision It’s about probabilities (not golden bullets)

  13. Evidence-Based Practice 1991Medicine 1998Education 1999Social care, public policy 2000Nursing 2000Criminal justice ????Management?

  14. Evidence-Based Practice

  15. Evidence-Based Practice

  16. Evidence-Based Practice

  17. Evidence-Based Practice

  18. Evidence-Based Practice

  19. What’s the evidence for evidence-based practice?

  20. Got evidence? • Forecasts or risk assessments based on the aggregated experience of multiple persons are more accurate than forecasts based on the experience of one person (provided that the forecasts are made independently before being averaged together) • Choudhry, N.K., et al. Systematic review: the relationshipbetweenclinicalexperienceandquality of health care. Ann Intern Med. 2005; 142 (4) • Silver, N. The Signaland the Noise: WhySoManyPredictionsFail - but SomeDon't. Penguin: London, 2012; p 286 and p 690 • Bauer A., et al. Forecast Evaluation with Cross Sectional Data: The Blue Chip Surveys. Economic Review, Federal Reserva bank of Atlanta, 2003. • Servan-Schreiber, E., et al. Prediction Markets: Does Money Matter? Electronic Markets, 2004: 14 (31). • Scott Armstrong, J. CombiningForecasts, in Principles of Forecasting: A handbookforResearchersandPractitioners, Kluwer AcademicPublishers, New York, 2001

  21. Got evidence? • Professional judgments based on hard data or statistical models are more accurate than judgments solely based on experiential evidence • Yaniv, I., & Choshen-Hillel, S. (2011). Exploiting the Wisdom of Othersto Make BetterDecisions: Suspending JudgmentReducesEgocentrismandIncreasesAccuracy, Journal of BehavioralDecision Making, 2012; 25 (5) p 427–434 • Lewis, M. Moneyball: The Art of Winning an Unfair Game. Barnes andNoble, 2003 • Grove, W.M. Clinical Versus Statistical Prediction. Journal of ClinicalPsychology, 2005; 61(10), p 1233–1243

  22. Got evidence? • Adecision based on the combination of different types of evidence (experiential, organizational, scientific) leads tobetteroutcomesthan a decision based on justone source of evidence • Antman, E.M. et al, A comparison of results of meta-analyses of randomized control trials andrecommendations of clinical experts, JAMA, 1992: 268 (2) p 240 – 248 • McNees, S.K. The Role of Judgment in MacroeconomicForecastingAccuracy, International Journal of Forecasting, 1990; 6 (3), p 28-299 • Silver, N. The Signaland the Noise: WhySoManyPredictionsFail - but SomeDon't. Penguin: London, 2012; p 286 and p 690 • Tetlock, P. E. Expert PoliticalJudgement, Princeton, NJ: Princeton University Press, 2006

  23. Evidence-Base Practice

  24. Post mortem analysis

  25. Evidence-based perspective • NOT: Did they make the right decision? • BUT: Assessment of the decision making process • What kind of evidence was there? • Was this the best available evidence? • Is there evidence from scientific research to support (or call into question) the approach taken?

  26. Decision making process

  27. Hospital, The Netherlands

  28. Organization • 550 beds • 3300 employees • 210 medical specialists • 225,000 admissions • Top Clinical & Teaching hospital • Structure: Business Units

  29. Decision: Leadership training All managers: • Board of directors • Division managers • Unit managers • Head nurses

  30. Cause I: reorganization From: 20 business units - 20 senior managers - 40 supervisors To: 20 business units – 8 senior managers - 40 supervisors

  31. Cause I: reorganization • Ambition • Experience • Education (MBA) • Assessment • Selection Gap

  32. Cause I: reorganization • larger span of control, more responsibilities = extra skills Theyneed extra skills We need extra skills

  33. Cause II: leadershipclimate Employee / Job satisfaction: leadership

  34. Cause II: leadershipclimate Board of directors

  35. Cause III: management development

  36. Project team • 10 members • Expertise (HR) • Representation (nurses, doctors, managers) • Support base

  37. Process: months! • Sessions with all stakeholders (medical staff, nurses, managers, staff council) • What is leadership? • What kind of leadership does the OLVG need? OLVG leadershipvision

  38. OLVG Leadershipvision • Passion and business • Inspire and connect • Leadership concerns us all

  39. Selection procedure Longlist: 30 • References (other hospitals, network), reputation Shortlist: 5 • Academic, Educational, Training, HR Consulting, Wild card First round: 3 • Paper pitch: proposal based on documents Final round: 1 • Carousel: board, medical staff, head nurses, managers

  40. Decision making process

  41. Decision making process What was the problem / issue What kind of evidence was there? Was this the best available evidence?

  42. 3 steps Problem identification Surfacing assumptions Logic model

  43. Step 1: What is the problem? • For which problem is ….. the solution? • For who(m) • Why? • How big? • How do we know (what is the evidence?)

  44. Decision making process What was the problem / issue What kind of evidence was there? Was this the best available evidence?

  45. Step 2: What are the assumptions? Assumptions are often hidden

  46. 3 steps Problem identification Surfacing assumptions Logic model

  47. Logic model

  48. Decision making process What was the problem / issue? What kind of evidence was there? Was this the best available evidence?

  49. Best available evidence? • Best available organizational evidence • Best available experiential evidence • Decision making process • Best available scientific evidence • Organizational values and stakeholders’ concerns

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