A framework to improve evidence-informedA framework to improve evidence-informed

decision-making in health service managementdecision-making in health service management

Ph.D Candidate in Health Care ManagementPh.D Candidate in Health Care Management

Tabriz University of Medical SciencesTabriz University of Medical Sciences

Iranian Center of Excellence in Health ManagementIranian Center of Excellence in Health Management

EdrisEdris HasanpoorHasanpoor

About this articleAbout this article

Journal: Journal: Journal of Australian Health ReviewJournal of Australian Health Review

Authors: Authors: Liang, Howard, Leggat, MurphyLiang, Howard, Leggat, Murphy

Received Received 31 May 201131 May 2011, accepted , accepted 12 October 201112 October 2011

Method of study: Method of study: A literature reviewA literature review

Citation: Citation: 11

Impact Factor of article: Impact Factor of article: 0.730.73

IndexedIndexed: : ProQuest, PubMed/Medline, Scopus, Thomson-Reuters/ISIProQuest, PubMed/Medline, Scopus, Thomson-Reuters/ISI

Hasanpoor, E. (2015). Hasanpoor, E. (2015). 3

IntroductionIntroduction

Since the 1960s, we have seen the rising importance of Since the 1960s, we have seen the rising importance of

evidence based medicine.evidence based medicine.

Evidence-informed decision-making (EIDM) in health Evidence-informed decision-making (EIDM) in health

service management has been debated and promoted service management has been debated and promoted

in the literature since the early 1990s.in the literature since the early 1990s.

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In fact, we ‘live in an era of evidence-based In fact, we ‘live in an era of evidence-based everything: what matters is what workseverything: what matters is what works

What is evidence-informed health services management?What is evidence-informed health services management?

Evidence-informed health services management Evidence-informed health services management is the is the

systematic application of the best available evidence to systematic application of the best available evidence to

management decision-making, aimed at improving the management decision-making, aimed at improving the

performance of health service organizations. performance of health service organizations.

The use of an The use of an evidence-informed approach evidence-informed approach has been has been

proposed to improve the practice of healthcare proposed to improve the practice of healthcare

management by improving the quality of managerial management by improving the quality of managerial

decisions.decisions.Hasanpoor, E. (2015). Hasanpoor, E. (2015). 5

StudiesStudies

Studies in the USA, Canada, UK, and Australia have Studies in the USA, Canada, UK, and Australia have

found that health service managers understand the found that health service managers understand the

importance of using evidence to improve management importance of using evidence to improve management

effectiveness and most health service managers effectiveness and most health service managers

report a desire to use and apply evidence.report a desire to use and apply evidence.

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Framework of evidence-informed decision-makingFramework of evidence-informed decision-making

This framework may be a useful guide to the This framework may be a useful guide to the development of interventions to improve the access development of interventions to improve the access and utilization of evidence to guide management and utilization of evidence to guide management decision-making within health service decision-making within health service organizations.organizations.

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MethodsMethods

A review of academic literature including all A review of academic literature including all descriptive, qualitative and quantitative studies and descriptive, qualitative and quantitative studies and discussions or reports discussions or reports was conducted to identify was conducted to identify studies that explored the practice of EIDM among studies that explored the practice of EIDM among health services managers.health services managers.

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following questionsfollowing questions

(1) How have different perspectives influenced how (1) How have different perspectives influenced how evidence has been defined?evidence has been defined?

(2) What are the barriers to the practice of EIDM?(2) What are the barriers to the practice of EIDM?

(3) What are the factors that may encourage the (3) What are the factors that may encourage the application of evidence to guide management application of evidence to guide management decision-making processes?decision-making processes?

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only journal articles and reports published in or after only journal articles and reports published in or after

1995 in English were included.1995 in English were included.

Databases: Databases: Medline (Ovid); ProQuest Health and Medline (Ovid); ProQuest Health and

Emerald and Google Scholar. Emerald and Google Scholar.

KeywordsKeywords used for the search included ‘health service used for the search included ‘health service

management’, ‘evidence-based management’, management’, ‘evidence-based management’,

‘evidence informed decision-making.‘evidence informed decision-making.

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In total, In total, 168 abstracts were reviewed 168 abstracts were reviewed by the by the researchers, with researchers, with 127 papers selected for content 127 papers selected for content review review based on their assessed relevance. based on their assessed relevance. Content Content screeningscreening further reduced the number of papers to further reduced the number of papers to

58 for 58 for content analysis, amongst which 46 content analysis, amongst which 46 were were included in developing this paper.included in developing this paper.

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What evidence is used for managementWhat evidence is used for managementdecision-makingdecision-making??

Anything that establishes a fact or gives reason for Anything that establishes a fact or gives reason for believing in something.believing in something.

Therefore, evidence can be categorized as being of Therefore, evidence can be categorized as being of two major types: two major types:

scientific evidence (the researchers’ view) .scientific evidence (the researchers’ view) .

colloquial evidence (the broader view outside the colloquial evidence (the broader view outside the

scientific community).scientific community).

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commonest forms of evidencecommonest forms of evidence

Howard et al.’s study confirmed that evidence such as Howard et al.’s study confirmed that evidence such as

internally developed datainternally developed data

information from within organizationinformation from within organization

best practice reportsbest practice reports

and own experienceand own experience

were the commonest forms of evidence used in guiding were the commonest forms of evidence used in guiding

managerial decision-making processes of Victorian health managerial decision-making processes of Victorian health

service managers.service managers.

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Type of evidence Type of evidence (Lomas et al)(Lomas et al)

context-free evidence: context-free evidence: evidence that provides a glimpse evidence that provides a glimpse

of what might be achieved in ideal circumstances and of what might be achieved in ideal circumstances and

creates context-free guidance.creates context-free guidance.

context-sensitive evidence: context-sensitive evidence: provides sensitive guidance provides sensitive guidance

on both what works and how it might be implemented in on both what works and how it might be implemented in

specific circumstances under consideration. specific circumstances under consideration.

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Barriers to the practice of evidence-Barriers to the practice of evidence-informed decision-makinginformed decision-making

Broader level Broader level (societal or industry-level beyond the organization);(societal or industry-level beyond the organization);

Organization;Organization;

Individual manager;Individual manager;

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Barriers to the practice of evidence-informed Barriers to the practice of evidence-informed decision-makingdecision-making

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Factors that may encourage the application of evidenceFactors that may encourage the application of evidenceto guide management decision-making processesto guide management decision-making processes

Interaction between researchers and management decision Interaction between researchers and management decision

makers.makers.

Organizational factors also encourage the uptake of evidence for Organizational factors also encourage the uptake of evidence for

decision-making:decision-making:

information systemsinformation systems

role of health service boardsrole of health service boards

The provision of incentivesThe provision of incentives

up-to-date informationup-to-date information

Strong leadershipStrong leadership

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Defining and promoting the success of previous evidence-Defining and promoting the success of previous evidence-informed decisionsinformed decisions

local negotiation;local negotiation;

The role of researchers in framing and presenting research;The role of researchers in framing and presenting research;

Research findings presented simply and succinctly;Research findings presented simply and succinctly;

quality;quality;

more involved in the research design;more involved in the research design;

new skills and capabilities.new skills and capabilities.

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Framework to guide the development of strategies in improving Framework to guide the development of strategies in improving the practice of evidence-informed decision-makingthe practice of evidence-informed decision-making

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The following framework (Fig. 1), developed from an The following framework (Fig. 1), developed from an

understanding of the above factors and their interactive understanding of the above factors and their interactive

relationships, may provide guidance on what strategies relationships, may provide guidance on what strategies

are to be developed and evaluated.are to be developed and evaluated.

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ConclusionConclusion

Evidence-informed decision-making is important in Evidence-informed decision-making is important in improving the quality of management decisions, improving the quality of management decisions, and hence, improved service delivery, effectiveness and hence, improved service delivery, effectiveness and efficiency.and efficiency.

In addition, the interactions between these factors are In addition, the interactions between these factors are

complex.complex.

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Furthermore, to maximize the benefit and relevance Furthermore, to maximize the benefit and relevance

of research evidence, of research evidence, researchers should more researchers should more

actively involve managers in setting research actively involve managers in setting research

agendas and guiding the appropriate presentation agendas and guiding the appropriate presentation

of research findings to facilitate the translation of of research findings to facilitate the translation of

research evidence produced research evidence produced to improved to improved

management practice in the health sector.management practice in the health sector.

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Evidence-based practiceEvidence-based practice

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ThanksThanks

Hasanpoor, E. (2015). Hasanpoor, E. (2015). 24