<strong>In</strong> <strong>Support</strong> <strong>of</strong> <strong>Evidence</strong>-<strong>Based</strong> <strong>Healthcare</strong> <strong>M<strong>an</strong>agement</strong>_________________________________________________________________________________________The authorBob HamlinBob Hamlin is a Principal Lecturer in Hum<strong>an</strong> Resource Development within WolverhamptonBusiness School. His major research interest is m<strong>an</strong>agement effectiveness.AcknowledgementsThe author wishes to acknowledge the assist<strong>an</strong>ce <strong>of</strong> Dr. Fiona Campbell <strong>an</strong>d Richard Jubb inthis study, <strong>an</strong>d also the support <strong>an</strong>d active participation <strong>of</strong> the Personnel Director <strong>an</strong>dPersonnel Officer <strong>of</strong> the NHS Trust Hospital.4 <strong>M<strong>an</strong>agement</strong> Research Centre 2001
<strong>In</strong> <strong>Support</strong> <strong>of</strong> <strong>Evidence</strong>-<strong>Based</strong> <strong>Healthcare</strong> <strong>M<strong>an</strong>agement</strong>_________________________________________________________________________________________<strong>In</strong> <strong>Support</strong> <strong>of</strong> <strong>Evidence</strong>-<strong>Based</strong> <strong>Healthcare</strong> <strong>M<strong>an</strong>agement</strong>: <strong>an</strong>empirical study <strong>of</strong> m<strong>an</strong>agerial effectiveness within <strong>an</strong> NHStrust hospital<strong>In</strong>troductionThis paper describes the findings <strong>of</strong> <strong>an</strong> org<strong>an</strong>isationally-based collaborative research project designedto identify the criteria <strong>of</strong> m<strong>an</strong>agerial effectiveness applying within <strong>an</strong> acute National Health Service(NHS) Trust Hospital, situated near Wolverhampton in the West Midl<strong>an</strong>ds, Engl<strong>an</strong>d, UK. The studybuilds upon similar research conducted by Hamlin (1988) within UK secondary schools, <strong>an</strong>d byHamlin <strong>an</strong>d Reidy (1997) within HM Customs & Excise, which is a major department <strong>of</strong> the BritishCivil Service. The study complements those <strong>of</strong> Fl<strong>an</strong>ag<strong>an</strong> (1990) <strong>an</strong>d Alimo-Metcalfe (1998) whohave also researched m<strong>an</strong>agerial/leadership effectiveness within the NHS. However, whereas thework <strong>of</strong> these latter researchers focused predomin<strong>an</strong>tly upon general m<strong>an</strong>agers <strong>an</strong>d members <strong>of</strong> topm<strong>an</strong>agement teams, the study reported here is concerned mainly with middle, junior <strong>an</strong>d first linem<strong>an</strong>agers.The research lends support to the concept <strong>of</strong> evidence-based m<strong>an</strong>agement which is beginning to beestablished within healthcare settings. Furthermore, the focus <strong>an</strong>d design <strong>of</strong> the study address some <strong>of</strong>the gaps found in m<strong>an</strong>y other empirical research studies on m<strong>an</strong>agerial <strong>an</strong>d leadership effectiveness,including those conducted in healthcare settings as identified, for example, by Shipper (1991),Shipper et al (1998), Shipper & White (1999) <strong>an</strong>d V<strong>an</strong> Der Velde et al (1999).The contextOver the past ten years or so evidence-based practice has become well established within medicineboth in Europe <strong>an</strong>d North America (McMaster University <strong>Evidence</strong>-based Medicine Working Group,1992; Stetler et al, 1998; Sackett et al, 1996; Gray, 1997). Starting from the early calls <strong>of</strong> Cochr<strong>an</strong>e(1972) for greater effectiveness <strong>an</strong>d efficiency within the National Health Service (NHS) in GreatBritain, evidence-based approaches to practice are now being applied not only in medicine but also inother healthcare pr<strong>of</strong>essions such as therapy, nursing, mental health <strong>an</strong>d child care. However, havingexplored in depth the various debates <strong>an</strong>d interpretations <strong>of</strong> the definitions <strong>of</strong> <strong>Evidence</strong>-<strong>Based</strong>Medicine (EBM) <strong>an</strong>d arrived at a common underst<strong>an</strong>ding, Bury <strong>an</strong>d Mead (1998) have provided aclearer working definition for evidence-based practice in other areas <strong>of</strong> healthcare th<strong>an</strong> the EBMdefinition <strong>of</strong>fered by Sackett et al (1996). They consider the following definition more helpful totherapists adopting evidence-based approaches to practice in the broader field <strong>of</strong> healthcare:<strong>Evidence</strong>-based practice is the conscientious, explicit <strong>an</strong>d judicious use <strong>of</strong> current best evidencein making decisions about the care <strong>of</strong> individual patients, integrating individual clinicalexpertise with the best available external clinical evidence from systematic research.From <strong>an</strong> Americ<strong>an</strong> perspective on the application <strong>of</strong> evidence-based practice <strong>an</strong>d the role <strong>of</strong> nursingleadership in a particular healthcare setting, Stetler et al (1998) found that in reality <strong>of</strong>ten “the bestevidence <strong>of</strong> well-established research findings was not available to subst<strong>an</strong>tiate various clinical,m<strong>an</strong>agerial or educational decisions”. Hence, in a similar way to Bury <strong>an</strong>d Mead (1998), they haveproduced a helpful summary definition “as part <strong>of</strong> [their] realistic goal to enh<strong>an</strong>ce pr<strong>of</strong>essional,evidence-based nursing practice” as follows:<strong>Evidence</strong>-based nursing de-emphasises ritual, isolated <strong>an</strong>d unsystematic clinical experiences,ungrounded opinions <strong>an</strong>d tradition as a basis for nursing practices........ <strong>an</strong>d stresses instead theuse <strong>of</strong> research findings <strong>an</strong>d, as appropriate, quality improvement data, other operational <strong>an</strong>devaluation data, the consensus <strong>of</strong> recognised experts <strong>an</strong>d affirmed experience to subst<strong>an</strong>tiate5 <strong>M<strong>an</strong>agement</strong> Research Centre 2001
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