Evidence-based Decision Making by Hospital Managers: A Systematic Review Methodology 1
Contents Brief Overview... 3 Aim... 4 Methodology... 4 Step 1... 4 Step2... 7 References... 11 2
Brief Overview Improving healthcare value is currently at the core of reform initiatives, and healthcare organizations that fail to incorporate evidence-based healthcare strategies in their current practices might jeopardize the status of their affairs (Stevans, Bise, McGee, Miller, Rocker, & Delitto, 2015). There has been a recent focus on how managers go about making their daily decisions, with a special interest in function of evidence and intuition in this process (Francis- Smythe, Robinson, & Ross, 2013). Rarely do managers take scientific evidence into consideration before making decisions, but it is surprising how much of a better position does looking into evidence place managers (McCormick, 2010). Evidence-based management (EBMgt) entails translating principles based on best evidence into organizational practices (Rousseau, 2006, p.256) in an aim to solve organizational issues that are most of the times problematic. Recently, there has been a dramatic increase in the interest in EBMgt, the supporters of which claims that managerial decisions should be based on what works as depicted by evidence (Tourish, 2013). Just like evidence-based medicine (EBM), EBMgt is not a very recent idea for Chester Barnard (1938) promoted the development of a natural science of organization to better understand the unanticipated problems associated with authority and consent (Rousseau, 2006, p. 260). Evidence for EBMgt is derived from four different sources which are the managers experiences, organizational values and input from various stakeholders, internal organizational evidence, and scientific research (Briner &Walshe, 2014). EBMgt is not a practice that either exists or is absent among managers, but a practice that varies in the levels of its adoption among them that is determined by the time these managers have available (McCormick, 2010). A vital assumption in EBMgt is that decision making should be as rational as possible and that personal interests should be replaced by those of the needs of other stakeholders (Tourish, 2013). Whenever possible, managers are always advised to base their decisions on scientific evidence rather than gut feeling and intuition (Tort-Martorell, Grima, & Marco, 2011, p. 599). Resorting to evidence to make decisions is a way to legitimate forms of decision-making that are alternatives to ideological or faith-based policy-making (Head, 2010, p.77). 3
Aim The aim of our study is to scope out the existing literature around the topic evidence-based decision making by hospital managers while specifically addressing the following questions: - What has been done around the area of evidence-based decision making by hospital managers and what are some of the gaps that should be addressed? - How is evidence-based decision making among managers in hospital contexts defined in the existing literature? - What frameworks exist that would help us assess various aspects of evidence-driven decision making among hospital managers? Methodology Since the topics that we are interested in conducting a systematic review on are spread across several fields, we found it most suitable to conduct a thorough search at the beginning in order to determine the key words that are most used by the relevant articles. Having mentioned that, the methodology of this study is made up of two steps: Step 1 Search Strategy We searched for results from 4 databases: PubMed CINAHL PsycINFO Cochrane Library Key terms used evidence AND based OR driven OR informed AND healthcare AND management Conditions: - Peer reviewed - Written in English language - Involve humans only 4
We decided to use in our search strategy only the combination mentioned above in order to end up with a comprehensive list of results and to be over-inclusive rather than under-inclusive since there is a limited number articles that handle the topic of evidence based decision making by managers in hospital contexts. The table below shows the results that we got per search from each database: Key words Database Article Count PubMed 4072 Cochrane 46 PsycINFO 11 Evidence based Healthcare Management CINAHL 21 PubMed 1070 Cochrane 10 PsycINFO 7686 Evidence Informed Healthcare Management CINAHL 1 PubMed 488 Cochrane 1 PsycINFO 6889 Evidence Driven Healthcare Management CINAHL 2847 Total: 23142 After exporting the results from the data bases into excel, we merged all the results from the same data base together in order to identify the duplications within each data base from the different searches which are: evidence-based/driven/informed healthcare management. These numbers are highlighted in green in the table below. We then merged all the results from each two databases at a time in order to identify the duplications among them. Duplication Table- General Search CINAHL Cochrane PsycINFO PubMed CINAHL 13 1 559 202 Cochrane 1 4 1 18 PsycINFO 559 1 263 285 PubMed 202 18 285 284 5
Filtering Strategy: After the arrangement of all the articles we started filtering them: Filter 1 We removed all the titles that clearly reflected clinical topics like: - "Distributed proton radiation therapy"-a new concept for advanced competence support. - "It's better for me to drink, at least the stress is going away": Perspectives on alcohol use during - Check it out! Decision-making of vulnerable groups about participation in a two-stage cardiometabolic health check: A qualitative study. Filter 2 We then removed articles that are clinical but were missed during the first filter and those that are, based on their titles, extremely irrelevant to our research topic like: - A comment on World War II repression. - "You are free to set your own hours": Governing worker productivity and health through flexibility and resilience. - I know I'm a good mom : Young, low-income mothers experiences with risk perception, intensive parenting ideology and parenting education programmes. Filter 3 We filtered the remaining articles by reading their abstracts and keeping the articles that include: - Evidence based decision making - Decision making in healthcare - Decision making by nurses and nurse managers - Practice guidelines development Filter 4 We filtered the articles by reading their full texts and keeping those that include: - Evidence based hospital processes, procedures, and design - Evidence based decision making by nurse managers - Evidence decision making by hospital/ healthcare organizations managers After this stage we went through the reference lists of the remaining 34 article and ended up with 20 articles which were further included in the study. 6
Below a tree that shows the numbers of articles at each filtering stage: Records identified from PubMed Records identified from CINAHL Records identified from PsycINFO Records identified from Cochrane Library n=5,630 n=2,869 n=14,586 n=57 Total Number of records: n=23,142 Records after duplication removal: n=21,512 Records after filter 1(filter by title): N=12,853 Records remaining after filter 2 (filter by title): 5075 Records remaining after filter 3( Filter by Abstract):347 Records remaining after filter 4(filter by full text):34 Step2 After this step, we were able to get the main key terms that were mentioned in the most relevant articles which are: 7
Results from Pubmed Results from PsycINFO Cochrane Results from CINAHL Total Number of Resuls decision makers decision making decision science evidence evidence informed improvement evidence-based design evidence-based management evidence-based practice knowledge flow knowledge management knowledge process knowledge transfer knowledge-based value creation organizational decision making research capacity building research transfer research use research-practice gap scientific evidence strength of evidence translation We decided to search for each of the key terms alone after adding to it AND healthcare AND management NOT clinical. Below is the list of the results per database and search input: Key Term Used decision makers AND healthcare AND management NOT clinical 89,053 28,039 133 10,711 127,936 decision making AND healthcare AND management NOT clinical 8
decision science AND healthcare AND management NOT clinical dissemination AND healthcare AND management NOT clinical evidence AND healthcare AND management NOT clinical evidence informed improvement AND healthcare AND management NOT clinical evidence based design AND healthcare AND management NOT clinical knowledge management AND healthcare AND management NOT clinical evidence based management AND healthcare AND management NOT clinical evidence-based practice AND healthcare AND management NOT clinical knowledge flow AND healthcare AND management NOT clinical knowledge process AND healthcare AND management NOT clinical knowledge transfer AND healthcare AND management NOT clinical knowledge-based AND healthcare AND management NOT clinical value creation AND healthcare AND management NOT clinical organizational decision making AND healthcare AND management NOT clinical research capacity building AND healthcare AND management NOT clinical research transfer AND healthcare AND management NOT clinical "research use"* AND healthcare AND management NOT clinical research-practice gap AND healthcare AND management NOT clinical scientific evidence AND healthcare AND management NOT clinical strength of evidence AND healthcare AND management NOT clinical translation AND healthcare AND management NOT clinical We ended up having: 127,936 results which will be filtered using their titles by two independent researchers. Filter 1 The first researcher will go through the results independently and highlight the articles that seem irrelevant based on their titles. The researchers will then meet and compare their lists and record 9
any disagreement in order to calculate the Kappa score. In case of any unsolved disagreement, the main researcher will decide whether or not the title should be included. Filter 2 Two researches will independently filter the remaining articles by reading their abstracts and keeping the articles that include: - Evidence based decision making - Decision making in healthcare - Decision making by nurses and nurse managers - Practice guidelines development except if they clearly reflect clinical topics Filter 3 Two researches will independently filter the articles by reading their full texts and keeping those that include: - Evidence based hospital processes, procedures, and design - Evidence based decision making by nurse managers - Evidence decision making by hospital/ healthcare organizations managers 10
References Briner, R. B., & Walshe, N. D. (2014). From passively received wisdom to actively constructed knowledge: teaching systematic review skills as a foundation of evidence-based management. Academy of Management Learning & Education, 13(3), 415-432. Francis-Smythe, J., Robinson, L., & Ross, C. (2013). The role of evidence in general managers decision-making. Journal of General Management, 38(4), 3-21. Head, B. W. (2010). Reconsidering evidence-based policy: Key issues and challenges. Policy and society, 29(2), 77-94. McCormick, D. W. (2010). Ethics & the 15 minute evidence-based manager: a review of a response to a critique published as Evidence-Based Management: Concept Cleanup Time? by Rob B Briner, David Denyer, and Denise M Rousseau (Academy of Management Perspectives, Nov 2009).Organization Management Journal, 7(4), 303-306. Rousseau, D. M. (2006). Is there such a thing as evidence-based management?. Academy of management review, 31(2), 256-269. Stevans, J. M., Bise, C. G., McGee, J. C., Miller, D. L., Rockar, P., & Delitto, A. (2015). Evidence-based practice implementation: case report of the evolution of a quality improvement program in a multicenter physical therapy organization. Physical therapy. Tort-Martorell, X., Grima, P., & Marco, L. (2011). Management by facts: The common ground between total quality management and evidence-based management. Total Quality Management & Business Excellence, 22(6), 599-618. Tourish, D. (2013). Evidence Based Management, or Evidence Oriented Organizing? A critical realist perspective. Organization, 20(2), 173-192. 11