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Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
Presentation Sioo Evidence-Based Practice (Dutch)
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Presentation Sioo Evidence-Based Practice (Dutch)

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  • 1. Evidence-Based Practice Sioo, 8 april 2013 Utrecht
  • 2. Evidence-based practice  Wat is het?  Waar komt het vandaan?  Hoe ziet het er uit in een opleiding?
  • 3. Evidence based practice: Wat is het?
  • 4. Definition Evidence based practice: Improve information to support decision making
  • 5. Evidence-based practiceUitgangspunt bij evidence-based practice isdat beslissingen gebaseerd dienen te zijnop een combinatie van kritisch denken ende best beschikbare evidence.
  • 6. Evidence based practice Met het begrip evidence wordt niet meer bedoeld dan informatie. Dit kan informatie zijn afkomstig uit wetenschappelijk onderzoek, maar ook interne bedrijfsinformatie en persoonlijke ervaring geldt als evidence’.
  • 7. Evidence based practice In principe neemt iedere manager dus beslissingen op basis van evidence. De meeste managers besteden echter nauwelijks aandacht aan de kwaliteit van de evidence waarop ze hun beslissingen baseren.
  • 8. Evidence-based practice: kritisch denken van verschillende informatiebronnen gebruik maken >> best available evidence? de evidence kritisch tegen het licht houden denken in termen van waarschijnlijkheid in plaats van golden bullets.
  • 9. Evidence based practice Best available Professional external evidence expertise and judgment Evidence-based decision Best available Stakeholders’ internal evidence values and concerns
  • 10. Evidence based practice:Waar komt het vandaan?
  • 11. What field is this? “there is a large research-user gap” “practitioners do not read academic journals” “the findings of research into what is an effective intervention are not being translated into actual practice” “academics not practitioners are driving the research agenda” “the relevance, quality and applicability of research is questionable” “practice is being driven more by fads and fashions than research” “many practices are doing more harm than good”
  • 12. Medicine: Founding fathers David Sackett Gordon Guyatt McMaster University Medical School, Canada
  • 13. How it all started
  • 14. Problem I: persistent convictions if you’re breathe into a bag hyperventilating
  • 15. Problem I: persistent convictions elderly people who have give them a drug that an irregular heartbeat are reduces the much more likely to die of number of coronary disease irregular beats
  • 16. How 40,000 cardiologists can be wrong In the early 1980s newly introduced anti-arrhythmic drugs were found to be highly successful at suppressing arrhythmias. Not until a RCT was performed was it realized that, although these drugs suppressed arrhythmias, they actually increased mortality. By the time the results of this trial were published, at least 100,000 such patients had been taking these drugs.
  • 17. Problem II: too much information More than 1 million articles in 40,000 medical journals per year (= 1995; now probably more than 2 million). For a specialist to keep up this means reading 25 articles every day (for a GP more than 100!)
  • 18. Problem I: persistent convictions Maslow, A.H. (1943). "A Theory of Human Motivation," Psychological Review 50(4) Wahba, M. A., & Bridwell, L. G. (1976). Maslow reconsidered: A review of research on the need hierarchy theory. Organizational Behavior and Human Performance, 15(2)
  • 19. True or false?1. Incompetent people benefit more from feedback than highly competent people.2. Task conflict improves work group performance while relational conflict harms it.3. Encouraging employees to participate in decision making is more effective for improving organizational performance than setting performance goals.
  • 20. How evidence-based are we?HR Professionals beliefs about effective human resource practices: correspondencebetween research and practice, (Rynes et al, 2002, Sanders et al 2008)  959 (US) + 626 (Dutch) HR professionals  35 statements, based on an extensive body of evidence  true / false / uncertain On average: 35% - 57% correct
  • 21. Problem II: too much information HRM: 1,350 articles in 2010 (ABI/INFORM). For an HR manager to keep up this means reading 3 to 4 articles every day (for a „general‟ manager more than 50!) BTW: most of the research is seriously flawed or irrelevant for practice
  • 22. David Sackett Half of what you learn in medical school will be shown to be either dead wrong or out-of-date within 5 years of your graduation; the trouble is that nobody can tell you which half. The most important thing to learn is how to learn on your own: search for the evidence! (Remember that your teachers are as full of bullshit as your parents)
  • 23. The 5 steps EBP: pull approach1. Formulate a focused question (Ask)2. Search for the best available evidence (Acquire)3. Critically appraise the evidence (Appraise)4. Integrate the evidence with your professional expertise and apply (Apply)5. Monitor the outcome (Assess)
  • 24. Evidence-Based Practice 1991 Medicine 1998 Education 1999 Social care, public policy 2000 Nursing 2000 Criminal justice ???? Management?
  • 25. Evidence based practice:Hoe ziet het er uit in de opleiding?
  • 26. Evidence-based practiceFase 1: Het ontwikkelen van kritisch en wetenschappelijkdenken dat leidt tot een professioneel-kritische attitude metbetrekking tot organisatievraagstukkenFase 2: Het kunnen formuleren van een expliciete vraag enop basis van deze vraag kunnen zoeken in online databasesnaar uitkomst van relevant wetenschappelijk onderzoek.Fase 3: Het kritisch kunnen beoordelen vanwetenschappelijke en organizational evidence (criticalappraisal)Fase 4: Uitkomst van wetenschappelijk onderzoek kunnentoepassen in de eigen beroepspraktijk (application of science)
  • 27. Evidence based practice Best available Professional scientific evidence expertise and judgment Evidence-based decision Best available Stakeholders’ organizational values and concerns evidence
  • 28. Trust me, 20 years of experience
  • 29. Bounded rationality
  • 30. Bounded rationality
  • 31. Het feilbare brein System 1  Snel, actie  Intuitief, associatief  shortcuts & biasses System 2  Langzaam (lui!)  Rationeel  Nadenken
  • 32. Bounded rationality neo cortex (systeem 2)limbische systeem en hersenstam (systeem 1)
  • 33. Systeem 1
  • 34. Systeem 1: het feilbare brein Seeing order in randomness Mental corner cutting Misinterpretation of incomplete data Halo effect False consensus effect Group think  Confirmation bias Self serving bias  Authority bias Sunk cost fallacy  Small numbers fallacy Cognitive dissonance reduction  In-group bias  Recall bias  Anchoring bias  Inaccurate covariation detection  Distortions due to plausibility
  • 35. Fase 1: Kritisch & wetenschappelijk denken 1. Denkfouten 2. Informatiebronnen 3. Mythbusting 4. Assumpties
  • 36. Richard Feynman“The first principle is that you must not foolyourself - and you are the easiest person tofool”.
  • 37. Seeing order in randomness Een Type I fout of een vals positief: denken dat er een patroon / verband is terwijl dat er in het echt niet is. Een Type II fout of een vals negatief: denken dat er geen patroon / verband is terwijl dat er in het echt wel is Dr. Michael Shermer (Director of the Skeptics Society)
  • 38. Het feilbare brein: patern recognition  Een Type I fout of een vals positief: denken dat het geritsel in de bosjes een gevaarlijk roofdier is, terwijl het gewoon de wind is (goedkoop foutje)
  • 39. Het feilbare brein: patern recognition  Een Type II fout of een vals negatief: denken dat het geritsel in de bosjes gewoon de wind is, terwijl het een gevaarlijk roofdier is (duur foutje)
  • 40. Het feilbare brein: patern recognition  Een Type I fout of een vals positief: denken dat het geritsel in de bosjes een gevaarlijk roofdier is, terwijl het gewoon de wind is (goedkoop foutje)  Een Type II fout of een vals negatief: denken dat het geritsel in de bosjes gewoon de wind is, terwijl het een gevaarlijk roofdier is (duur foutje)
  • 41. Het feilbare brein: patern recognition Ook ervaren mensen en experts zien patronen en verbanden waar ze niet zijn. stress & lifestyle peptic ulcer
  • 42. Oct 2005 Peptic ulcer – an infectious disease!This years Nobel Prize in Physiology or Medicine goes to Barry Marshall and RobinWarren, who with tenacity and a prepared mind challenged prevailing dogmas. Byusing technologies generally available (fibre endoscopy, silver staining ofhistological sections and culture techniques for microaerophilic bacteria), theymade an irrefutable case that the bacterium Helicobacter pylori is causing disease.By culturing the bacteria they made them amenable to scientific study. In 1982, when this bacterium was discovered by Marshall and Warren, stress and lifestyle were considered the major causes of peptic ulcer disease. It is nowfirmly established that Helicobacter pyloricauses more then 90% of duodenal ulcers.The link between Helicobacter pyloriinfection and peptic ulcer disease has beenestablished through studies of humanvolunteers, antibiotic treatment studies andepidemiological studies.
  • 43. Errors and Biases of Human Judgmentsuperstitious superstitious rituals rituals more stress = more prone to biases
  • 44. Errors and Biases of Human Judgment
  • 45. Beliefs vs Evidence“What gets us into trouble is not what wedont know,its what we know for sure that just isnt so.” Mark Twain
  • 46. Het feilbare brein: patern recognition Ook slimme mensen houden er verkeerde ideeën op na, niet omdat ze dom of eigenwijs zijn, maar omdat het de meest logische conclusie is op basis van hun eigen ervaringen. (systeem 1 doet altijd mee!)
  • 47. Evidence-based practiceFase 1: Het ontwikkelen van kritisch en wetenschappelijkdenken dat leidt tot een professioneel-kritische attitude metbetrekking tot organisatievraagstukkenFase 2: Het kunnen formuleren van een expliciete vraag enop basis van deze vraag kunnen zoeken in online databasesnaar uitkomst van relevant wetenschappelijk onderzoek.Fase 3: Het kritisch kunnen beoordelen vanwetenschappelijke en organizational evidence (criticalappraisal)Fase 4: Uitkomst van wetenschappelijk onderzoek kunnentoepassen in de eigen beroepspraktijk (application of science)
  • 48. The 5 steps EBP1. Formulate a focused question (Ask)2. Search for the best available evidence (Acquire)3. Critically appraise the evidence (Appraise)4. Integrate the evidence with your professional expertise and apply (Apply)5. Monitor the outcome (Assess)
  • 49. Formulate a focused question
  • 50. Focused question? Does team-building work? What are the costs and benefits of self-steering teams? What are the success factors for culture change? Does management development improve the performance of managers? Does employee participation prevent resistance to change? How do employees feel about 360 degree feedback?
  • 51. Foreground question?  Does team-building work?  What is a „team‟?  What kind of teams?  In what contexts/settings?  What counts as „team-building‟?  What does „work‟ mean?  What outcomes are relevant?  Over what time periods?
  • 52. Answerable question: PICOC P = Population I = Intervention or success factor C = Comparison O = Outcome C = Context
  • 53. 2. Finding the best available evidence
  • 54. Searching evidence What do we search?
  • 55. What do we search? Current Information Overview of a subject General background Academic Information Statistical Information Theories about a subject Company information
  • 56. Peer reviewed journals
  • 57. Searching for evidence
  • 58. Databases  ABI/INFORM  Business Source Elite  PsycINFO  Web of Knowledge  ERIC  Google Scholar
  • 59. Searching for evidence
  • 60. Searching evidence How do we search? Search Strategy
  • 61. Search strategy Two types of search strategies Snowball method Building blocks method
  • 62. Search strategy
  • 63. Hands on instruction
  • 64. Example: merger
  • 65. Question Imagine you are a consultant, your client is the board of directors of a large Canadian health-care organization. The board of directors has plans for a merger with a smaller healthcare organization in a nearby town. However, it‟s been said that the organizational culture differs widely between the two organizations. The board of directors asks you if this culture-difference can impede a successful outcome of a merger. Most of them intuitively sense that cultural differences matter, but they want an evidence-based advice.
  • 66. Answerable question: PICOC What else would you like to know?
  • 67. Answerable question: PICOC P: What kind of Population are we talking about? Middle managers, back-office employees, medical staff, clerical staff? O: What kind of Outcome are we aiming for? Employee productivity, return on investment, profit margin, competitive position, innovation power, market share, customer satisfaction? P/C: And how is the assumed cultural difference assessed? Is it the personal view of some managers or is it measured by a validated instrument?
  • 68. Answerable question: PICOC According to the board the objective of the merger is to integrate the back-office of the two organizations (ICT, finance, purchasing, facilities, personnel administration, etc.) in order to create economy of scale. The front offices and primary process of the two organizations will remain separate. The cultural difference is not objectively assessed (it is the perception of the senior managers of both organizations).
  • 69. Answerable question: PICOC P = back office employees in a healthcare organisation I = merger, integration back office C = status quo O = economy of scale C = different organizational culture, unequal
  • 70. Evidence-based practiceFase 1: Het ontwikkelen van kritisch en wetenschappelijkdenken dat leidt tot een professioneel-kritische attitude metbetrekking tot organisatievraagstukkenFase 2: Het kunnen formuleren van een expliciete vraag enop basis van deze vraag kunnen zoeken in online databasesnaar uitkomst van relevant wetenschappelijk onderzoek.Fase 3: Het kritisch kunnen beoordelen vanwetenschappelijke en organizational evidence (criticalappraisal)Fase 4: Uitkomst van wetenschappelijk onderzoek kunnentoepassen in de eigen beroepspraktijk (application of science)
  • 71. What is the best research design?  Randomized controlled study?  Grounded theory approach?  Cohort / panel study?  Qualitative field research?  Longitudinal study?  Post-test only study?  Survey?  Action research?  Case study?
  • 72. What is the best design? quants vs quallies, positivists vs post structuralist, etc
  • 73. What is the BEST car?
  • 74. Research designs Which design for which question?
  • 75. Effect vs Non-effect
  • 76. Types of questions Does it work? Does it work better than ....? Does it have an effect on ....?Effect What is the success factor for ....? What is required to make it work ...? Will it do more good than harm?
  • 77. Types of questions: non-effectNeeds: What do people want or need?Attitude: What do people think or feel?Experience: What are peoples’ experiences?Prevalence: How many / often do people / organizations ...?Procedure: How can we implement ...?Process: How does it work?Explanation: Why does it work?Economics: How much does it cost?
  • 78. Internal validity
  • 79. Internal validity internal validity = indicates to what extent the results of the research may be biased and is thus a comment on the degree to which alternative explanations for the outcome found are possible.
  • 80. Causal relations We are pattern seeking primates: we are predisposed to see order and causal relations in the world
  • 81. CausalityWhen do we know there is a causal relation? 1. Are the "cause" and the "effect” related? measurements, effect size 1. Does the "cause" precede the "effect" in time? before and after measurement 2. Are there no plausible alternative explanations for the observed effect? randomization, control group
  • 82. Bias & Confounding Research shows: Shoe size > quality of handwriting Smoking youngsters > better lung function
  • 83. Levels of internal validity
  • 84. Which design for which question?Explanation
  • 85. Different types of research questionsrequire different types of research designs,but ...
  • 86. Best research design?
  • 87. Step 3: Critical appraisal of studies
  • 88. How to read a research article?
  • 89. Critical appraisal: quick and dirty Is the study design appropriate to the stated aims? Are the measurements likely to be valid and reliable? Was there a relevant effect size? Is the outcome (population, type of organization) generalizable to your situation?
  • 90. Appraisal Critical appraisal questionnaires www.cebma.org/ebp-tools
  • 91. Aantal te laat betalers neemt toe Best available Professional scientific evidence expertise and judgment Evidence-based decision Best available Stakeholders’ organizational values and concerns evidence
  • 92. CAT: Critically Appraised Topic
  • 93. CAT: structure 1) Background / context 2) Question (PICOC) 3) Search strategy 4) Results / evidence summary max 3 pag. 5) Findings 6) Limitations 7) Recommendation
  • 94. CAT-walk

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