In Support of Evidence-Based Healthcare Management: an ...

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In Support of Evidence-Based Healthcare Management_________________________________________________________________________________________practice....... inherent to evidence-based practice are critical thinking and research utilisationcompetencies.... and the ability to use research as a process.Just as Stetler et al (1998) view evidence-based practice as applying to managerial and educationaldecisions as well as to clinical decisions, Bury and Mead (1998) claim that evidence-based healthcarein Britain goes beyond EBM. Its scope includes evidence-based commissioning/purchasing,evidence-based policy, evidence-based patient choice and evidence-based management.Various calls for evidence-based management have been made in the British literature. For example,although evidence-based medicine can draw on more clear-cut scientific research than that availablein the field of management, Rosemary Stewart (1998) argues it is still desirable to practice evidencebasedmanagement. To her, Evidence-Based Management is an attitude of mind which:-thinks in terms of evidence for decisions and about the nature of the evidence-asks questions such as “What is happening?, How is it happening? Why? and What are theconsequences?”-is aware of the potential limitations of the different answers-is interested in research to try to find the answers or at least to reduce the ignorance.She suggests managers need to build a questioning approach into their everyday management practiceand encourage the creation of a research culture. However, to develop a research culture requires atleast one senior manager to act as a role model.With regard to evidence-based management, Axelsson (1998) points out, from a broader Europeanperspective, that in many healthcare organisations where large-scale organisational and managerialchanges have taken place, physicians have started to ask for empirical evidence on the efficiency andeffectiveness of the different organisational models introduced. Drawing on the work of Ham et al(1995) he notes that many healthcare managers and politicians are asking for more scientificknowledge upon which to make their decisions on organisational design. Hence he strongly promotesthe idea of an evidence-based approach to healthcare management in order to improve its practice aswell as to stimulate research on the organisation and management of healthcare. Referring to thework of Altman (1994), he draws attention to the fact that the practice of EBM has exposed variousgaps in the medical knowledge base, with a large proportion of published medical research lackingeither relevance or sufficient methodological rigour to be reliable enough to answer clinical questions.However, the identification of such gaps has been helpful in cumulatively generating new medicalresearch, which has continuously improved the practice of medicine. Encouraged by this, he claimsthat the evidence-based approach can be applied to the practice of management in general and tohealthcare management in particular. However, there needs to be some modification in approach fortwo main reasons. Firstly, because there are important methodological differences between medicalresearch and management research, the former being quantitative and empirical in character with thelatter being more qualitative and phenomenological, and secondly, because of the significantdifferences and variability in the educational and professional backgrounds of managers compared tophysicians. Taking these differences into consideration Axelsson (1998) takes Evidence-BasedManagement as meaning:managers should examine the scientific basis for their practice by learning to search andcritically appraise empirical evidence from management research as a basis for their decisions.This means they should be asking many questions, such as:What do we know empirically about different aspects of organisation and management? Whatis the scientific state of this knowledge? What is the effectiveness and efficiency of differentmodels of management? What is the experience of these models from different organisations?6 Management Research Centre 2001
In Support of Evidence-Based Healthcare Management_________________________________________________________________________________________These questions are similar to those posed by Rosemary Stewart and have important implications forboth management practice and management research. For example Evidence-Based Managementmeans that managers should be:looking for inspiration and support for their decisions in the empirical evidence frommanagement research instead of being influenced by popular fashion or the simplerecommendations of consultants and management gurus. This should lead to increasingdemands from managers for organisational research in order to produce empirical evidenceupon which practical management can be based. It may also lead to a more applied orientationin organisational research whereby management researchers associate themselves more with thepractical problems of management inside different organisations, maintain closer contact withmanagement practice, and communicate their findings in a more easily accessible and usefulway.Recognising the practice of Evidence-Based Management needs time and that many managers maysay they have no time to spare for it, Axelsson (1998) also points out that that is what manyphysicians said when EBM was first introduced. However, they found very soon that “they couldimprove the quality of their decisions so much [by adopting an EBM approach] that it was well worththe time and effort”. Today evidence-based practice is a widespread feature of medical and healthcarepractice both in America, Canada, Britain and many other European countries, and is beginning to beapplied also in healthcare management and healthcare education.However, although much research has been done in the field of management, it is also the case thatfew studies have produced empirical results that can be generalised beyond particular organisationalsettings. For example, resulting from a wide ranging historical search for a strong empirical base tosupport the concept of evidence-based management in healthcare, Axelsson (1998) concluded thatafter nearly one hundred years of research on organisation and management the practical knowledgein the field seems to be back almost on the same (very low) scientific level as when the researchstarted. As he observes, most of the empirical research programmes carried out have been casestudies of organisations, projects or change processes with few yielding results that could begeneralised from one organisation to another. In many instances the research appears to have becomean end in itself with little relevance for practical management. This criticism has more recently beenmade by other commentators. For example, in its call for papers on ‘Practitioner and PracticegroundedResearch’ for a Special Research Forum for the 2001 Academy of Management Meeting inWashington, D.C., the Academy drew attention to the fact that “academic (management) research isincreasingly criticized for being too narrow, method driven, not responsive to real organizationalneeds, or simply irrelevant relative to the demands of a knowledge driven approach”. Drawing on theconclusions of Lowendahl & Revang (1998) it argues that these criticisms “reflect a need for theacademic community to explore new research methods and processes”. This needs to be done byaddressing the ‘double hurdle’ of conducting academically rigorous and relevant managementresearch that is not just “explanatory science concerned with knowing the ‘what’ of management, butis also concerned with discovering the ‘how’ of management through the production of managementknowledge in the context of application”. Furthermore, the Academy’s call was for papers onpractitioner and practice grounded management research that creatively used alternative approachesincluding quantitative methods combined synergistically with qualitative methods.Although the empirical research presented in this article is based on a case study aimed atunderstanding one aspect of organisational life within an NHS trust hospital, namely the criteria ofmanagerial effectiveness applying within that organisation, the research has been designed and carriedout with the intent of drawing out practical and generalisable conclusions on the basis of results thathave been generated using both qualitative and quantitative methods in a synergistic way.Much research has been done over the past thirty years or so on managerial behaviour. However,most has been focused almost exclusively on the absolute or relative frequency of observed7 Management Research Centre 2001
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