EBMgt Course Module 2: Where Does It Come From


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EBMgt Course Module 2: Where Does It Come From

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EBMgt Course Module 2: Where Does It Come From

  1. 1. Postgraduate CourseEvidence based management:Where does it come from?
  2. 2. Postgraduate Course “there is a large research-user gap” “practitioners do not read academic journals” “the findings of research into what is an effective interventionare not being translated into actual practice” “academics not practitioners are driving the research agenda” “the relevance, quality and applicability of research isquestionable” “practice is being driven more by fads and fashions thanresearch” “many practices are doing more harm than good”What field is this?
  3. 3. Postgraduate CourseMcMaster University Medical School, CanadaMedicine: Founding fathersDavid Sackett Gordon Guyatt
  4. 4. Postgraduate CourseHow it all started
  5. 5. Postgraduate Course More than 1 million articles in 40,000 medical journals peryear (= 1995; now probably more than 2 million). For aspecialist to keep up this means reading 25 articles everyday (for a GP more than 100!) Most of the new insights and treatmentmethods don‟t reach the target groupProblem I: too much information
  6. 6. Postgraduate CourseProblem I: too much information HRM: 1,350 articles in 2010 (ABI/INFORM). For an HRmanager to keep up this means reading 3 to 4 articlesevery day (for a „general‟ manager more than 50!)
  7. 7. Postgraduate CourseProblem II: persistent convictionsif you’rehyperventilatingbreathe into a bag
  8. 8. Postgraduate CourseProblem III: jumping to conclusionselderly people who havean irregular heartbeat aremuch more likely to die ofcoronary diseasegive them a drug thatreduces thenumber ofirregular beats
  9. 9. Postgraduate CourseHow 40,000 cardiologists can be wrongIn the early 1980s newly introduced anti-arrhythmic drugs were found to be highlysuccessful at suppressing arrhythmias.Not until a RCT was performed was it realizedthat, although these drugs suppressedarrhythmias, they actually increased mortality.The CAST trial revealed Excess mortality of56/1000.By the time the results of this trial werepublished, at least 100,000 such patients hadbeen taking these drugs.
  10. 10. Postgraduate CourseDavid Sackett Half of what you learn in medical school will beshown to be either dead wrong or out-of-datewithin 5 years of your graduation; the trouble is thatnobody can tell you which half. The most important thing to learn is how to learnon your own. (Remember that your teachers are as full of bullshitas your parents)
  11. 11. Postgraduate CourseEvidence-Based Practice1991 Medicine1998 Education1999 Social care2000 Nursing2000 Criminal justice???? Management?
  12. 12. Postgraduate Course
  13. 13. Postgraduate CourseManagement: Founding Mother
  14. 14. Postgraduate CourseJeffrey Pfeffer Robert SuttonManagement: Founding Fathers
  15. 15. Postgraduate Course“Good managers use both individual managerialexpertise and the best available external evidence, andneither alone is enough. Without managerial expertise,practice risks becoming tyrannized by evidence, for evenexcellent external evidence may be inapplicable to orinappropriate for an individual organization or team.Without current best evidence, practice risks becomingrapidly out of date, to the detriment of organizations andemployees.”Evidence based decision
  16. 16. Postgraduate CourseIndividual Managerial Expertise Managerial skills and managerial judgment Vital for determining whether the evidence appliesto an individual organization (division, team) at alland, if so, howEvidence based decision
  17. 17. Postgraduate Course5-step approachEBMgt is a 5-step approach1. Formulate an answerable question (PICOC)2. Search for the best available evidence3. Critical appraise the quality of the found evidence4. Integrate the evidence with managerial expertiseand organizational concerns and apply5. Monitor and evaluate the results