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Substantial and sustained change is inevitable for U.S. hospitals, driven by the Medicare and Medicaid cost inflation curve and embodied in regulatory initiatives and reforms. This study explores the conception that evidence-based management is necessary but not sufficient for 21st century success in health care organizations. Success will require challenging and changing the organization's dominant logic, substituting a more transformational style of problem analysis and decision making. In order for evidence-based management decisions to transform organizations, the organizational culture must be ready to adopt transformation changes. The outcomes of this shift in management style are dramatic changes in worker engagement and retention and a reinforcing cycle of performance improvement efforts. We use a series of examples to illustrate changes in the dominant logic and to identify how the combination of evidence-based management and a new dominant logic results in a fundamental and highly productive shift in how problems are framed and solved. We conclude with recommendations for changing the dominant logic – such as visioning, sensemaking, process questioning, getting the right people together, rewarding innovation, and overcoming risk aversion – all necessary for transforming the dominant logic, allowing evidence-based management techniques to flourish.

The purpose of this article is to provide a viewpoint on a controversial aspect of evidence‐based medicine (EBM) and its application to clinical decision making and healthcare policy. To draw attention to the potential for using EBM as a rationalising tool, as opposed to rationalising treatment options, and to discuss how legitimacy in the decision‐making process may be secured.

A range of academic commentary and case law is reviewed. A model for the legitimacy of due process is suggested through the application of the framework for the “accountability for reasonableness”.

Provides information about sources indicating their relevance and where they can be found. Emphasises that NHS organisations and trusts need to enhance the legitimacy of due process through clinical governance.

Presents a viewpoint designed to stimulate debate, which is based on a critical evaluation of the literature as well as contemporary quality initiative issues in the context of clinical governance.

A useful source of guidance for NHS Trust decision makers, healthcare practitioners and those involved with patient support initiatives.

This paper provides an original viewpoint on a topical and important issue and develops the concept of legitimacy and decision making that is delivered by the application of legal principles through clinical governance.

Realism is emerging as a paradigm for research and explanation in the natural and social sciences. A realist framework is elaborated and applied to the four possible situations that may generate the observations of randomised, controlled trials. It is demonstrated that by using two realist concepts “mechanism” and “context” a number of misinterpretations of such trials from within the dominant empiricist paradigm may be rectified. Evidence based medicine should adopt realism to temper a misleading empiricism, this will involve relegating statistical arguments to their proper subsidiary place and adopting an adequate theory of causation.

The growing acceptance of evidence‐based decision support systems in healthcare organizations has resulted in recognition of data quality improvement as a key area of both strategic and operational management. Information managers are faced with their emerging role in establishing quality management standards for information collection and application in the day‐to‐day delivery of health care. In the USA, rigid data‐based practice and performance standards and regulations related to information management have met with some resistance from providers. In the emerging information‐intensive healthcare environment, managers are beginning to understand the importance of formal, continuous data quality assessment in health services delivery and quality management. Variation in data quality management practice poses quality problems in such an environment, since it precludes comparative assessments across larger markets or areas, a critical component of evidence‐based quality assessments. In this study a national survey of health information managers was employed to provide a benchmark of the degree of such variation, examining how quality management practices vary across area indicators. Findings here suggest that managers continue to employ paper‐based quality assessment audits, despite nationwide mandates to adopt system‐based measures using aggregate data analysis and automated quality intervention. The level of adoption of automated quality management methods in this study varied significantly across practice characteristics and areas, suggesting the existence of data quality barriers to cross‐market comparative assessment. Implications for healthcare service delivery in an evidence‐based environment are further examined and discussed.

Until today a central register for medical guidelines has not been established in Austria. Hence, the study at hand aims to identify important success factors for medical guidelines in Austria in order to fully support the future activities of organisations developing these guidelines.

Using a specially‐developed questionnaire, 137 potential Austrian guideline developers were asked about the anticipated benefits of a common guideline register and a standardised method for guideline development by means of a complete inventory count for Austria.

Approximately 73 per cent of Austrian guideline developers know of existing online guideline registers. Nearly 77 per cent know neither of an instrument to evaluate the guidelines in a methodical way, nor of the Council of Europe's recommendation. Around 63 per cent expect an improvement in the quality of the guidelines by implementing a standardised method.

The present study provides the results of the first complete inventory count of guideline developers in Austria and can be used as an orientation for future activities.

The realisation of the success factors would increase the quality of national guidelines and would boost the implementation of best practices such as evidence‐based‐medicine into the Austrian health care system.

The study shows for the first time the necessity of support in order to improve the quality of Austrian guidelines from the point of view of potential developers.

The Health Information Research Unit (HIRU) at McMaster University in Hamilton, Ontario, Canada, was founded to meet the information needs that were quickly becoming apparent in the course of teaching critical appraisal methods for the practice of evidence‐based medicine. Librarians have worked in HIRU from its inception and their activities include teaching searching skills to clinicians, collecting and analyzing data for developing methods hedges to increase retrieval of high‐quality clinical articles, evaluating study methods of articles for four evidence‐based journals, and developing more sophisticated ways to deliver electronic information to clinicians. This article summarizes these developments.

To show the range and richness of the roles performed over the years, some of the cycles and projects with which HIRU has been involved and how librarians have fit in are described. Not all projects have been “successful”, but often the unsuccessful ones are as informative as – if not more so than – those that met one's expectations.

One of the main outcomes of the work is the recognition that many job opportunities in areas of informatics exist for librarians and other information professionals. Other groups are acknowledging that librarians can have substantial input into information products and anyone considering health sciences librarianship as a career should realize that many of the skills obtained during training will equip one for work in many non‐traditional settings.

It is felt that a contribution has been made to the continuing education of many of one's peers and help given to build one's research base and information products. The professional relationships that have been established because of these interactions have been rich and rewarding. Anyone interested in a career in health librarianship is encouraged to consider the opportunities available in research and development and other non‐traditional (non‐library) settings.

This qualitative study aims to examine key stakeholders' perspectives of primary care group/trust prescribing strategies. Within the context of general practice prescribing, the paper also debates the wider issue of whether GPs' prescribing autonomy is under threat from managerial expansion following recent organisational changes in primary care.

Data were obtained from focus groups and a series of individual semi‐structured interviews with GPs and key primary care organisation stakeholders.

The data underlie a tension between the managerial objective of cost‐restraint and GPs' commitment to quality improvement and individual clinical patient management. In presenting both managerial and medical narratives, two divergent and often conflicting discourses emerge, which leads to speculation that managerial attempts to constrain prescribing autonomy will achieve only limited success. The contention is that GPs' discourse features as a challenge to a managerial discourse that reflects attempts to regulate, standardise and curtail clinical discretion. This is due not only to GPs' expressed hegemonic ideals that clinical practice centres on the interests of the individual patient, but also to the fact that the managerial discourse of evidence‐based medicine encapsulates only a limited share of the knowledge that GPs draw on in decision making. However, while managers' discourse presented them as unwilling to impose change or directly challenge clinical practice, evidence also emerged to suggest that is not yet possible to be sufficiently convinced of the future retention of prescribing autonomy. On the other hand, the use of peer scrutiny posed an indirect managerial influence on prescribing, whilst the emergence of prescribing advisors as analysts of cost‐effectiveness may threaten doctors' dominance of medical knowledge.

There is a continuing need to analyse the impact of the new managerial reforms on primary care prescribing.

This study provides a snapshot of managerial and GP relations at a time of primary care transition.

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.

In an increasingly litigious environment, contemporary public sector organisations are encountering myriad challenges, not the least of which is the manner in which they manage one of their most valuable resources – information. This is occurring at a time when more sophisticated information technology is made available at the desktop of knowledge workers who can develop increasingly autonomous work practices. Consequently, if public agencies are to have confidence that they can provide accurate and reliable evidence of their decision making activities to government, they face an important challenge – the development of rigorous strategies and policies supported by an appropriate information management culture. A coherent corporate governance framework is an important mechanism to facilitate and ensure compliance with regulations and the development of appropriate internal accountability arrangements.

Currently there is a widespread movement, not only amongst practitioners but also managers, purchasers and policy makers, to promote evidence‐based health care. There is therefore a growing concern that practitioners should be able to efficiently access and appraise evidence. This paper discusses some of the requirements which are necessary to enable nurses to achieve this goal. It is based on three sources of evidence: the evaluation of a workshop which was designed to facilitate practitioners' appraisal and use of research; a qualitative study of practitioners' and managers' attitudes to research; and the authors' experience of working in this field. A framework is suggested whereby not just the accruement of skills, but other requisites such as a positive culture, an appreciation of the wide range of research methodologies which might inform nursing, and an exploration of sources of evidence other than research, require attention.