evidence-based heathcare logistisc

Congres Evidence-Based Zorglogistiek, 13 oktober 2011

Evidence-Based Management

What is it?

Why do we need it?

How does it look like in practice?

1. Evidence based management:

What is it?

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Definition

Evidence-based management means making decisions

about the management of employees, teams or

organizations through the conscientious, explicit and

judicious use of four sources of information:

1. The best available scientific evidence

2. Organizational facts, metrics and characteristics

3. Stakeholders’ values and concerns

4. Practitioner expertise and judgment

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Four sources

Evidence is not the same as ‘proof’ or ‘hard facts’

Evidence can be

- so strong that no one doubts its correctness, or

- so weak that it is hardly convincing at all

What is evidence?Postgraduate Course

McMaster University Medical School, Canada

Medicine: Founding fathers

David Sackett Gordon Guyatt

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Management: Founding MotherPostgraduate Course

Jeffrey Pfeffer Robert Sutton

Management: Founding FathersPostgraduate Course

2. Evidence-based management:

Why do we need it?

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EBMgt: some basic assumptionsPostgraduate Course

Research produced by management scholars could be useful to

organizations

Drawing on available evidence (including research produced by

academics) is likely to improve decisions

Organizations do not appear to be strongly aware of nor use

research findings

EBMgt is a potentially useful way of thinking about how we can

incorporate research evidence into decision-making

Reason 1:

Errors and Biases of Human Judgment

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Seeing order in randomness

Mental corner cutting

Misinterpretation of incomplete data

Halo effect

False consensus effect

Reinterpreting evidence

Group think

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Confirmation bias

Authority bias

In-group bias

Recall bias

Anchoring bias

Inaccurate covariation detection

Distortions due to plausibility

Seeing order in randomness Mental corner cutting


Halo effect



Group think

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Confirmation bias

Authority bias

In-group bias

Recall bias

Anchoring bias



We are predisposed to see order, pattern and causal

relations in the world.

Patternicity: The tendency to find meaningful patterns in

both meaningful and meaningless noise.

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We are patern seeking primates: association learning

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Points of impact of V-1 bombs in London

A Type I error or a false positive, is

believing a pattern is real when it is not

(finding a non existent pattern)

A Type II error or a false negative, is

not believing a pattern is real when it is

(not recognizing a real pattern)

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Dr. Michael Shermer

(Director of the Skeptics Society)

A Type I error or a false positive: believe that the

rustle in the grass is a dangerous predator when it is

just the wind (low cost)

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A Type II error or a false negative: believe that the

rustle in the grass is just the wind when it is a

dangerous predator (high cost)

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Pattern detection problem

Assessing the difference between a Type I and

Type II error is highly problematic (especially in

split second ‘life and death’ situations), so the

default position is to assume

all patterns are real.

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Jennifer Whitson, University of Texas Austin, corporate environments

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Erroneous beliefs plaque both experienced

professionals and less informed laypeople alike.

stress peptic ulcer

Peptic ulcer – an infectious disease!

This year's Nobel Prize in Physiology or Medicine goes to Barry Marshall and Robin

Warren, who with tenacity and a prepared mind challenged prevailing dogmas. By

using technologies generally available (fibre endoscopy, silver staining of

histological sections and culture techniques for microaerophilic bacteria), they

made an irrefutable case that the bacterium Helicobacter pylori is causing disease.

By culturing the bacteria they made them amenable to scientific study.

In 1982, when this bacterium was discovered by Marshall and Warren, stress and

lifestyle were considered the major causes of peptic ulcer disease. It is now

firmly established that Helicobacter pylori

causes more then 90% of duodenal ulcers.

The link between Helicobacter pylori

infection and peptic ulcer disease has been

established through studies of human

volunteers, antibiotic treatment studies and

epidemiological studies.

Oct 2005

Postgraduate Course


Doctors, teachers, lawyers and managers hold many

erroneous beliefs, not because they are ignorant or

stupid, but because they seem to be the most sensible

conclusion consistent with the available evidence.

They hold such beliefs because they seem to be the

irresistible products of their own professional experience.

They are the products, not of irrationality, but of flawed

rationality


Mental corner cutting


Halo effect



Group think

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Confirmation bias

Authority bias

In-group bias

Recall bias

Anchoring bias



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Group think: management fads

The nearly-forgotten fads:

Scientific Management/Taylorism

Business Process Reengineering

Management by results

Excellence

Total Quality Management

Learning Organizations

Knowledge Management

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The fads that haven’t been forgotten

(yet):

Talent management

Management development

Executive coaching

Emotional intelligence

Employee engagement

Knowledge management

Myers Briggs Type Indicator

Belbin Team Roles

Postgraduate Course


“And there we see the power of any big

managerial idea (or fad). It may be smart, like

quality, or stupid, like conglomeration. Either

way, if everybody's doing it, the pressure to do it

too is immense. If it turns out to be smart, great.

If it turns out to be stupid, well, you were in good

company and most likely ended up no worse off

than your competitors. Your company's board

consists mostly of CEOs who were probably

doing it at their companies. How mad can they

get?

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The true value of conventional management

wisdom is not that it's wise or dumb, but that it's

conventional. It makes one of the hardest jobs in

the world, managing an organization, a little

easier. By following it, managers everywhere see

a way to drag their sorry behinds through

another quarter without getting fired. And isn't

that, really, what it's all about?”

(Colvin, 2004, Fortune)

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So?

Managers seem to be extremely good at generating

ideas, theories, and explanations that have the ring of

plausibility. They may be relatively deficient, however,

in evaluating and testing those ideas once they are

formed.

This requires that we think critically about experience,

question our assumptions, and challenge what we

think we know

(Show me the evidence!)

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Reason 2:

De ‘buitenwereld’ wordt steeds kritischer

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Probleem 2: kritische geluiden

“Managers maken Nederland ziek ... Steeds

meer vakmensen (zoals docenten, verpleegkundigen,

artsen) hebben het gevoel dat ze worden aangestuurd

door managers die van het vak geen verstand hebben

maar wel de dienst uitmaken.”

Ad Verbrugge

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“Of het nu gaat om een ziekenhuis of een dropfabriek,

te veel managers hebben de pretentie dat ze alles

kunnen managen zonder ook maar te letten op de

inhoud van het werk. Het zijn figuren die als een vlo

van de ene "uitdaging" naar de andere springen, een

spoor van verbittering en vernieling

achter zich latend.”

Geert Mak


Postgraduate Course

“Nog meer managers, nog meer reorganisaties, nog

meer power point-presentaties, nog meer holle

retoriek over topprestaties en topkwaliteit. De

groeiende korst van nepfuncties die onze bedrijven,

scholen en andere organisaties nutteloos belasten

wordt almaar dikker .”

Dorien Pessers


Postgraduate Course

Brede maatschappelijke ontwikkeling

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“Waar de overheid, de dokter, de pedagoog en

de manager vroeger een eenvoudig beroep op

hun autoriteit konden doen, zullen zij nu met

getallen en statistiek hun gelijk moeten

aantonen.”


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Evidence based medicine

Evidence based education

Evidence based criminology

Evidence based social welware

Evidence based management?


Evidence based management:

How does it look like in practice?

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Four sources

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JAMA, 1992

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Push vs Pull

Push: teaching (management) principles

based upon a convergent body of

research and telling students what to do.

Pull: teaching (managers) how to find,

appraise and apply the outcome of

research (evidence) by themselves

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The 5 steps of ‘pull’ EBP

1. Formulate an answerable question

2. Search for the best available evidence

3. Critically appraise the evidence

4. Integrate the evidence with your managerial

expertise and organisational concerns and apply

5. Monitor the outcome

Answerable question

Postgraduate Course

I am a consultant, my client a large health-care

organization. The board of directors has plans for a

merger with a smaller healthcare organization. However,

it’s been said that the organizational culture differs widely

between the two organizations. The board want’s to

know if this can impede a successful outcome.

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P = Population or problem

I = Intervention or successfactor

C = Comparison

O = Outcome

C = Context

Answerable question: PICO(C)

Answerable question: PICOC

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P: What kind of Population are we talking about? Middle managers,

back-office employees, medical staff, clerical staff?

O: What kind of Outcome are we aiming for? Employee productivity,

return on investment, profit margin, competitive position, innovation

power, market share, customer satisfaction?

P/C: And how is the assumed cultural difference assessed? Is it the

personal view of some managers or is it measured by a validated

instrument?

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Where do we search?Postgraduate Course

How do we search?Postgraduate Course

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Critical appraisal

How to read a research article?

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Critical appraisalPostgraduate Course

1. Study designs

2. Levels of evidence

3. Bias / confounding

4. Effect sizes

5. External validity

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Which study for which question?

Research designs

The “best” evidence depends on the question type !

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Levels of evidence

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4. Integrate the evidence with your

managerial expertise and organisational

concerns and apply


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1. Is your organization / division / population so different from those in the study that its results cannot apply?

2. How relevant is the study to what you are seeking to understand or decide?

3. What are your organization’s potential benefits and harms from the intervention?

4. Is the intervention feasible in your setting?

Organization concerns

Always ask yourself to what extent the evidence is applicable in your situation:

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Monitor the outcome

Uitkomst gemeten?

Voormeting?

Controlegroep?

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Do a trial!

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Monitor the outcome

Business Process Redesign?

Six Sigma?

Lean management?

Lean Six Sigma?

TOC/ Theory of Constraints?

Performance Management?

Of …..

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Vragen?

evidence-based heathcare logistisc

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