Skip to content

Evidence-based management – an era of optimism?

October 23, 2012
Martin Marshall Martin Marshall is Lead for Improvement Science London and Professor of Healthcare Improvement at UCL.

Many factors influence the decisions made by managers and clinicians about how best to organise and deliver healthcare. Scientific evidence has traditionally played a small part but this has the potential to change, aided by the emergence of the science of improvement.

People responsible for improving how we implement what we know are now facing a similar challenge to that faced by those providing clinical care 20 years ago. Prior to the advent of the Evidence Based Medicine (EBM) movement, clinicians often did what they did because they had always done it that way, or because their teachers told them to do it, or because it felt like the right thing to do. EBM challenged this, introducing a more systematic approach to clinical decision making which drew less on personal experience and more on rigorous and systematic research evidence. Is there anything that the nascent evidence-based management (EBMx, if you’ll excuse yet another acronym) movement can learn from the now mature EBM movement?

Ten years ago, David Naylor, a clinical academic from the University of Toronto, reflected back on the first decade of EBM and described four eras in its development. First, the era of optimism framed the problem as a lack of knowledge and the solution as promoting a better understanding of research, in the belief that passive diffusion of knowledge would make a difference. This was quickly followed by the second era, the era of innocence lost and regained, when the sheer volume of the literature became clear and we saw the emergence of evidence summaries in the form of guidelines. The disappointing uptake of guidelines led to the third era of industrialisation, in which a massive investment was made to purposefully and sometimes aggressively promote their use. And now we have entered the era of systems engineering, drawing on human factors learning and focusing on clinical decision making as a task, that, like any other form of ‘work’ needs to be made as easy as possible with the aid of information technologies.

Where do we place evidence-based management on this evolutionary pathway? Pessimists might claim that the movement is not so much nascent as barely conceived. There are a few optimists around (mea culpa) but not many. Even on a good day, optimists will acknowledge that the implementation literature is even more vast, amorphous, inaccessible and full of gaps than the clinical literature. Efforts have been made by some, most notably the NHS Confederation, the SDO (Service Delivery and Organisation) R&D programme, the Kings Fund and the nine CLAHRCs (Collaborations for Leadership in Applied Health Research and Care) across England, to produce evidence summaries in areas such as care integration and hospital mergers, but the impact of these efforts on the decision making process is at best uncertain.

Whilst the idea of industrialisation or systems engineering of implementation evidence feels like a long way off, this is precisely where we need to head, and quickly. The challenges of scaling up and systematising the use of implementation evidence are significant, given the nature of the evidence and the readiness of the decision makers to operate differently, but they are not insurmountable. The investments made by the National Institute for Health Research into knowledge mobilisation and a second round of CLAHRCs will help.

But perhaps the biggest challenge is that managerial decision making will always be different from clinical decision making. By its very nature, it will always be less rational, more political, more influenced by pragmatism and ideology. Whilst the use of evidence will improve the decision making process, it will never dominate it. So perhaps we need to think about an additional era in its evolution, an era that we might call enlightenment version 2.0. In the eighteenth century, the enlightenment movement promoted science over rationalism and authority. Version 2.0 doesn’t turn the clock back, so much as acknowledge that in some realms of life decision making is more complex, imperfect and irrational than in others. We desperately need good scientific evidence to inform management decisions, but perhaps we need to think more creatively about how to generate and mobilise that evidence.

38 Comments leave one →
  1. November 6, 2012 12:35 pm

    As someone working in quality improvement I find this lack of evidence base a real problem. Even on a national level it is difficult to fund quality initiatives beyond start up, because of this many projects will have a pilot and then die. Is there a ‘how to guide’ to incorporating effective but simple evaluation into the design of projects, without paying a university a large sum of money? Or a way of pooling experiences from individual quality initiatives to make evaluation possible?

  2. martinmarshall permalink
    November 7, 2012 10:19 am

    Emma
    Thanks for your comment. I agree that the absence of an evidence base for much of the work that improvers do does make it more difficult to make a case for investing resources in improvement. And you are also right that we all need to be more committed to evaluating improvement activities in as rigorous a way as possible and then disseminate any transferable lessions that arise from the evaluation. I am not aware of much in the way of accessible and simple guides to evaluating complex improvement interventions – indeed much of the evaluation literature is complex and inaccessible. Some people have suggested that producing a simple ‘how to’guide for front line staff who are not in a position to do large scale evaluations would be useful. What do you think?
    Martin

    • November 7, 2012 10:30 am

      Hi Martin,
      Yes I agree. For example I manage a national project for inflammatory bowel disease services. We are keen to adapt some work that NHS diabetes have done in terms of patient self management. NHS diabetes are keen to work with us, especially as it will involve a very different patient demographic and different mode of organisation (the patient’s annual review, where this work is focused, occurs mostly in secondary care in IBD, rather than the primary care). I think this has great potential, but to be really useful the project could do with some plans for evaluation before we start. However we are going to have to find funds for setting this project up, travel for training etc which is not already in our budget. This will be a lot of work, even for just a few thousand pounds let alone finding an additional £20,000 for formal evaluation!
      A guide on how to plan some cheap but effective evaluation at the design phase of a project would be really useful.
      Emma

  3. April 14, 2014 5:07 am

    Great info. Lucky me I discovered your website by accident (stumbleupon).
    I have book marked it for later!

  4. April 17, 2014 4:26 pm

    I really like your blog.. very nice colors & theme.
    Did you design this website yourself or did
    you hire someone to do it for you? Plz answer back
    as I’m looking to design my own blog and would like to know where u got this from.

    thanks

  5. April 23, 2014 3:04 am

    They are known for reliability, security and stability in their data
    extraction services. ) High-sugar bananas and
    grapes and all dried fruit are on the no-no list. Two studies presented at the Federation of American Societies for Experimental Biology’s Experimental Biology 2006 provide new evidence for the beneficial effects
    (and biochemical actions) of cinnamon as an anti-inflammatory agent and support earlier findings
    of its power as an anti-oxidant agent and an agent
    able to lower cholesterol, triglycerides, and glucose, and improve how
    well insulin functions.

  6. April 23, 2014 10:54 am

    An outstanding share! I’ve just forwarded this onto a co-worker who had been doing a little homework on
    this. And he actually bought me breakfast simply
    because I stumbled upon it for him… lol. So allow me
    to reword this…. Thanks for the meal!! But yeah, thanks for spending the
    time to discuss this topic here on your web page.

  7. April 23, 2014 2:52 pm

    It’s very straightforward to find out any
    topic on web as compared to books, as I found this paragraph at
    this web site.

  8. April 24, 2014 12:11 am

    The gameplay in League of Legends is extremely refined and well developed.

    After defeating a slew of androids, the team track Calculator
    down who deploys more robots to take them down, later realizing Calculator himself was an android and eventually leading to
    Damian to quit the team. I am not sure whether this method also work for hack zen in Zenonia 4 1.

  9. April 24, 2014 10:27 am

    Hi there would you mind sharing which blog platform you’re working
    with? I’m looking to start my own blog soon but I’m having a difficult time choosing between BlogEngine/Wordpress/B2evolution and
    Drupal. The reason I ask is because your design and style seems different then most blogs and I’m looking for something completely unique.
    P.S Apologies for being off-topic but I had to ask!

  10. May 3, 2014 4:19 pm

    Please let me know if you’re looking for a article writer for your site.
    You have some really great articles and I think I would be a good asset.

    If you ever want to take some of the load off, I’d love to
    write some material for your blog in exchange for a link back to mine.
    Please send me an email if interested. Thank
    you!

  11. May 4, 2014 1:37 am

    whoah this weblog is excellent i love studying your articles.
    Stay up the good work! You realize, lots of persons are hunting around
    for this information, you can help them greatly.

  12. May 4, 2014 2:34 am

    I like what you guys are usually up too. This kind of clever work and coverage!
    Keep up the good works guys I’ve included you guys to our blogroll.

  13. May 4, 2014 9:14 am

    I visited several sites except the audio feature for audio songs current at this web page is in fact marvelous.

  14. May 4, 2014 2:48 pm

    My developer is trying to convince me to move to .net from PHP.
    I have always disliked the idea because of the expenses.
    But he’s tryiong none the less. I’ve been using
    WordPress on various websites for about a year and am concerned about switching to another platform.
    I have heard fantastic things about blogengine.net. Is there
    a way I can import all my wordpress content into it?
    Any kind of help would be greatly appreciated!

  15. May 4, 2014 9:59 pm

    I need to to thank you for this good read!! I definitely enjoyed every
    little bit of it. I have got you saved as a favorite to check out new things you post…

  16. May 5, 2014 1:04 am

    Whats up this is kind of of off topic but I was wanting to know if blogs use WYSIWYG
    editors or if you have to manually code with HTML.

    I’m starting a blog soon but have no coding know-how so
    I wanted to get advice from someone with experience. Any help would be greatly appreciated!

  17. May 5, 2014 9:21 am

    Hi, I do think this is an excellent blog. I stumbledupon it ;
    ) I will revisit yet again since I saved as a favorite
    it. Money and freedom is the greatest way to change, may
    you be rich and continue to help others.

  18. May 5, 2014 10:19 am

    Hi, its pleasant piece of writing on the topic of media print, we
    all be aware of media is a fantastic source of information.

  19. May 5, 2014 3:28 pm

    Right away I am going to do my breakfast, once having my breakfast coming again to read additional news.

  20. May 14, 2014 4:46 pm

    Hi there Dear, are you really visiting this web page regularly,
    if so then you will without doubt take nice know-how.

  21. May 14, 2014 6:09 pm

    I have been surfing online more than 3 hours as of late, yet I
    never found any fascinating article like yours.
    It is lovely worth sufficient for me. Personally, if all web owners and bloggers
    made excellent content material as you did, the internet
    can be much more helpful than ever before.

  22. May 23, 2014 2:56 am

    Hello, i think that i saw you visited my blog so
    i came to “return the favor”.I’m attempting to
    find things to improve my site!I suppose its ok to use a few of your ideas!!

  23. May 25, 2014 8:23 pm

    Hello! This post couldn’t be written any better!
    Reading through this post reminds me of my old room mate!
    He always kept talking about this. I will forward this page to him.
    Fairly certain he will have a good read. Many thanks for sharing!

  24. May 29, 2014 6:10 am

    I was recommended this web site by my cousin. I’m not sure whether
    this post is written by him as no one else know such detailed about my problem.
    You’re incredible! Thanks!

  25. June 1, 2014 7:49 am

    I absolutely love your blog and find a lot of your post’s to be exactly I’m
    looking for. can you offer guest writers to write content for you?
    I wouldn’t mind composing a post or elaborating on a lot of the subjects you write concerning
    here. Again, awesome web log!

  26. June 3, 2014 8:03 pm

    5 Black – Berry client collaboration software offers users
    many ways to work together on a project to accomplish the
    tasks that separately work together to accomplish
    a common goal. One other matter corporations often have
    on making use of completely new systems is if
    the new technological know-how works with current modern technology.
    o Peak of inflated expectations – climb – fuelled by unrealistic forecasts of its potential, media
    hype, and investor frenzy.

  27. June 6, 2014 7:34 pm

    Appreciating the hard work you put into your blog and in depth information you offer.
    It’s good to come across a blog every once
    in a while that isn’t the same outdated rehashed information. Fantastic read!
    I’ve saved your site and I’m adding your RSS feeds to my Google account.

  28. June 6, 2014 8:40 pm

    I couldn’t refrain from commenting. Very well written!

  29. July 12, 2014 1:14 am

    The service was reasonable just like many such services.
    If you take any sort of business or would like to make
    money blogging online, it is very important have your individual website.

    This is usually a really confusing task if a person is completely unfamiliar using
    the structure of folders and files.

  30. July 18, 2014 8:44 pm

    Hello, I think your blog might be having browser compatibility issues.

    When I look at your blog site in Opera, it looks fine but when opening in Internet Explorer, it has some overlapping.
    I just wanted to give you a quick heads up! Other then that, terrific blog!

  31. July 19, 2014 4:31 am

    It’s a pity you don’t have a donate button! I’d certainly donate to this brilliant blog!
    I suppose for now i’ll settle for bookmarking and adding your RSS
    feed to my Google account. I look forward to new updates and will
    talk about this site with my Facebook group. Chat soon!

  32. July 22, 2014 5:04 am

    What’s up everybody, here every one is sharing these kinds of familiarity, therefore it’s pleasant to read this website, and I used to pay a visit this
    web site everyday.

  33. July 26, 2014 11:20 pm

    Exfellent beat ! I wsh to apprentice while you amend your web site, how could i subscribe for a blog site?
    The account aided me a acceptable deal. I had been tiny bit
    acquainted of this your broadcast provided bright clear idea

  34. August 12, 2014 2:25 am

    Have you ever considered writing ann e-book or guest authoring on other blogs?
    I have a blog centered on the same subjects you discuss and
    would really like to have you share some stories/information. I know my subscribers would value your
    work. If you’re even remotely interested, feel free to shoot
    me an e mail.

  35. September 28, 2014 11:35 am

    Attractive ѕection of content. I just stumbled սpon your
    web site and inn accession capital tօ assert that Ι acquire actuually enjoyed account ƴoսr blkog posts.
    Anywɑy I’ll ƅe subscribing tο your feeds and even I achievement yօu access
    consistently rapidly.

  36. October 20, 2014 11:36 pm

    all the time i used to read smaller content which as well
    clear their motive, and that is also happening with this article which
    I am reading at this place.

  37. January 20, 2015 4:04 am

    Hi there would you mind stating which blog platform you’re using?
    I’m going to start my own blog soon but I’m having a tough tme selecting between BlogEngine/Wordpress/B2evolution and
    Drupal. The reason I ask is because your layout
    seems different then mokst blogs and I’m looking for something completely unique.
    P.S My apologies ffor being off-topic but I had to ask!

Have your say

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: