Search results

The relatively recent attention that evidence-based decision making has received in health care management has been at least in part due to the profound influence of evidence-based medicine. The result has been several comparisons in the literature between the use of evidence in health care management decisions and the use of evidence in medical decision making. Direct comparison, however, may be problematic, given the differences between medicine and management as they relate to (1) the nature of evidence that is brought to bear on decision making; (2) the maturity of empirical research in each field (in particular, studies that have substantiated whether or not and how evidence-based decision making is enacted); and (3) the context within which evidence-based decisions are made. By simultaneously reviewing evidence-based medicine and management, this chapter aims to inform future theorizing and empirical research on evidence-based decision making in health care settings.

The rise of evidence‐based medicine and more recently evidence‐based policy reflect the increasing importance of evidence as a basis for the organisation and delivery of health care. Evidence‐based practice is central to the “modernisation” of health care in current UK policy. The latest manifestation of this process is the emergence of evidence‐based management in health care. This paper examines the development of evidence‐based approaches in health care and questions the appropriateness of such an approach to management. The problems inherent in applying the principles of EBP to management are explored and alternative apporoach based on the notion of craft is suggesteed as more practical and realistic.

Presents models suggesting how research evidence can best be operationalised within health care commissioning. Models were derived from data gathered from surveys of Scottish health board managers and GP fundholders regarding the use of information in commissioning from 1995 to 1997. Feedback on the models was obtained subsequently from practitioners in 1998. Two models, one for health board managers and the other for GPs, are presented. These include critical success factors in achieving evidence‐based commissioning and factors that are likely to predispose and precipitate evidence‐based practice. Given a culture demanding transparency, accountability and continuing improvement, the models provide tools for reflection, evaluation and planning. In addition, they identify a pragmatic role for managers in evidence‐based commissioning and provide a framework for audit.

The purpose of this paper is to examine whether healthcare leaders use evidence-based management (EBMgt) when facing major decisions and what types of evidence healthcare administrators consult during their decision-making. This study also intends to identify any relationship that might exist among adoption of EBMgt in healthcare management, attitudes towards EBMgt, demographic characteristics and organizational characteristics.

A cross-sectional study was conducted among US healthcare leaders. Spearman’s correlation and logistic regression were performed using the Statistical Package for the Social Sciences (SPSS) 23.0.

One hundred and fifty-four healthcare leaders completed the survey. The study results indicated that 90 per cent of the participants self-reported having used an EBMgt approach for decision-making. Professional experiences (87 per cent), organizational data (84 per cent) and stakeholders’ values (63 per cent) were the top three types of evidence consulted daily and weekly for decision-making. Case study (75 per cent) and scientific research findings (75 per cent) were the top two types of evidence consulted monthly or less than once a month. An exploratory, stepwise logistic regression model correctly classified 75.3 per cent of all observations for a dichotomous “use of EBMgt” response variable using three independent variables: attitude towards EBMgt, number of employees in the organization and the job position. Spearman’s correlation indicated statistically significant relationships between healthcare leaders’ use of EBMgt and healthcare organization bed size (r_s = 0.217, n = 152, p < 0.01), attitude towards EBMgt (r_s = 0.517, n = 152, p < 0.01), and the number of organization employees (r_s = 0.195, n = 152, p = 0.016).

This study generated new research findings on the practice of EBMgt in US healthcare administration decision-making.

Hospital manager decisions can have a significant impact on service effectiveness and hospital success, so using an evidence-based approach can improve hospital management. The purpose of this paper is to identify evidence-based management (EBMgt) components and challenges. Consequently, the authors provide an improving evidence-based decision-making framework.

A total of 45 semi-structured interviews were conducted in 2016. The authors also established three focus group discussions with health service managers. Data analysis followed deductive qualitative analysis guidelines.

Four basic themes emerged from the interviews, including EBMgt evidence sources (including sub-themes: scientific and research evidence, facts and information, political-social development plans, managers’ professional expertise and ethical-moral evidence); predictors (sub-themes: stakeholder values and expectations, functional behavior, knowledge, key competencies and skill, evidence sources, evidence levels, uses and benefits and government programs); EBMgt barriers (sub-themes: managers’ personal characteristics, decision-making environment, training and research system and organizational issues); and evidence-based hospital management processes (sub-themes: asking, acquiring, appraising, aggregating, applying and assessing).

Findings suggest that most participants have positive EBMgt attitudes. A full evidence-based hospital manager is a person who uses all evidence sources in a six-step decision-making process. EBMgt frameworks are a good tool to manage healthcare organizations. The authors found factors affecting hospital EBMgt and identified six evidence sources that healthcare managers can use in evidence-based decision-making processes.

This manuscript discusses the main findings gathered through a systematic literature review aimed at crystallizing the state of art about evidence-based management (EBMgt) in healthcare. The purpose of this paper is to narrow the main gaps in current understanding about the linkage between sources of evidence, categories of analysis and kinds of managerial decisions/management practices that different groups of decision-makers put in place. In fact, although EBMgt in healthcare has emerging as a fashionable research topic, little is still known about its actual implementation.

Using the Scopus database as main source of evidence, the authors carried out a systematic literature review on EBMgt in healthcare. Inclusion and exclusion criteria have been crystallized and applied. Only empirical journal articles and past reviews have been included to consider only well-mature and robust studies. A theoretical framework based on a “process” perspective has been designed on these building blocks: inputs (sources of evidence), processes/tools (analyses on the sources of evidence), outcomes (the kind of the decision) and target users (decision-makers).

Applying inclusion/exclusion criteria, 30 past studies were selected. Of them, ten studies were past literature reviews conducted between 2009 and 2014. Their main focus was discussing the previous definitions for EBMgt in healthcare, the main sources of evidence and their acceptance in hospitals. The remaining studies (n=20, 67 percent) were empirical; among them, the largest part (n=14, 70 percent) was informed by quantitative methodologies. The sources of evidence for EBMgt are: published studies, real world evidence and experts’ opinions. Evidence is analyzed through: literature reviews, data analysis of empirical studies, workshops with experts. Main kinds of decisions are: performance assessment of organization units, staff performance assessment, change management, organizational knowledge transfer and strategic planning.

This study offers original insights on EBMgt in healthcare by adding to what we know from previous studies a “process” perspective that connects sources of evidence, types of analysis, kinds of decisions and groups of decision-makers. The main findings are useful for academia as they consolidate what we know about EBMgt in healthcare and pave avenues for further research to consolidate this emerging discipline. They are also useful for practitioners, as hospital managers, who might be interested to design and implement EBMgt initiatives to improve hospital performance.

The purpose of this paper is to explore and assess barriers and opportunities for evidence-based management (EBMgt) and decision-making in healthcare systems of the small island developing states (SIDSs) of English-speaking Caribbean.

The study utilized grounded theory to collect and analyze data on experiences and perceptions of 20 senior managers/leaders from seven Ministries of health in the region. It used semi-structured, in-depth interviews comprising open-ended questions. Data analysis comprised open, focused and theoretical coding.

EBMgt and decision-making is not a prominent approach taken by top officials of health systems because of internal and external barriers to its use. Indeed the absence of a culture of decision-making based on evidence pervades the public services of Caribbean island states. Notwithstanding, there are opportunities for meaningful application of this management/leadership strategy.

To the author’s knowledge, this is the first assessment of the application of EBMgt to health systems of SIDSs of the Caribbean. This paper is concerned with the approach to decision-making in health systems across island states and lends support to the use of evidence in decision-making and policy development. It provides useful direction for policy makers, and senior managers/leaders of these systems.

The paper aims to take a reflective stance on the relationship between policy/evidence and practice, which, the authors argue, is conceptually under‐developed. The paper aims to show that current research perspectives fail to frame evidence and policy in relation to practice.

A qualitative study was conducted in the English NHS in four Primary Care Trusts (PCTs). Seventy‐five observations of meetings and 52 semi‐structured interviews were completed. The approach to data analysis was to explore and reconstruct narratives of PCT managers' real practices.

The exploratory findings are presented through two kinds of narratives. The first narrative vividly illustrates the significance of the active involvement, skills and creativity of health care practitioners for policy implementation. The second narrative elucidates how problems of collaboration among different experts in PCTs might emerge and affect evidence utilisation in practice.

The findings exemplify that policies are made workable in practice and, hence, policy makers may also need to be mindful of practical intricacies and conceive policy implementation as an iterative process.

The contribution of this paper lies in offering an alternative and important perspective to the debate of utilisation of policy/evidence in health care management and in advancing existing understanding of health care management practice. The paper's rich empirical examples demonstrate some important dimensions of the complexity of practice.

The purpose of this paper is to describe a methodology to deal with conformance checking through the implementation of computer-interpretable-clinical guidelines (CIGs), and present an application of the methodology to real-world data and a clinical pathway for radiotherapy-related oncological treatment.

This methodology is implemented by a software able to use the hospital electronic health record data to assess the adherence of the actual executed clinical processes to a clinical pathway, monitoring at the same time management-related efficiency and performance parameters, and ideally, suggesting ways to improve them.

Three use cases are presented, in which the results of conformance checking are used to compare different branches of the executed guidelines with respect to the adherence to ideal process, temporal distribution of state-to-state transitions, and overall treatment efficacy, in order to extract data-driven evidence that could be of interest for the hospital management.

This approach has the result of applying management-oriented data mining technique on sequential data, typical of process mining, to the result of a conformity check between the preliminary knowledge defined by clinicians and the real-world data, typical of CIGs.

The medical consultation is one of the requirements in diseases diagnosis and patient treatment. In addition, a high-quality consultation is a fundamental demand of patients, and it is one of the rights of every patient. The purpose of this paper is to identify factors affecting the high-quality consultation in medical communications.

The following electronic databases were searched: MEDLINE (via PubMed), Web of Science, Cochrane, EMBASE, Scopus and ProQuest until December 2018. In addition, the authors searched Google Scholar. Qualitative and quantitative studies were assessed using the Critical Appraisal Skills Programme, Qualitative Checklist and the Center for Evidence-Based Management appraisal checklist, respectively. A stepwise approach was conducted for data synthesis.

Of 3,826 identified studies, 29 met the full inclusion criteria. Overall, after quality assessment of studies, 25 studies were included. The studies were conducted in the USA (n=6), the UK (n=6), the Netherlands (n=4), Canada (n=2), Belgium (n=2), Poland (n=2), Germany (n=1), Iran (n=1), Finland (n=1), Austria (n=1), Qatar (n=1), Denmark (n=1) and China (n=1), and five studies were excluded. Data synthesis showed that high-quality consultation consisted of three main categories: structural (4 main themes with 26 sub-themes), process (2 main themes with 33 sub-themes) and outcome (3 main themes with 12 sub-themes) quality.

Using the indicators of consultation quality improvement can develop physicians’ clinical competence and skills. Decision makers can use them to monitor and evaluate physicians’ performance. A high-quality consultation can be useful in social prescribing that helps patients to manage their disease.