What is the added value of evidence-based practice for managers withinthe field of hospital care?Proof of concept
Teaching Hospital- 6 managersUniversity Hospital- 4 managersEvidence based pilot
Phase 1: Training managers in the principles of EBPPhase 2: Examination of the current decision makingprocesses that managers are usingPhase 3: Evaluation of 4 completed projects from anEB perspective (retrospective)Phase 4: Making EB recommendations for 4 newprojects (prospective)Phase 5: EvaluationEvidence based pilot
Decision making process Focus on procedures instead of evidence Internal politics and power struggles No critical appraisal of the evidence at hand Relying on anecdotal evidence (workshops, bestpractices, popular management books, consultants) One option (sometimes two) Bias: Outcome, Halo, Confirmation, etc.
leadership training: dm process No problem definition No organizational evidence consulted Selection of training companies based onexperience, recommendation or reputation No explicit selection criteria / procedure ‘Best’ presentation has won: one size fits all
leadership training: scientific evidence 15 meta analyses, 5 relevant 37 (‘systematic’) reviews, 2 relevant Lots of relevant primary studies
leadership training: scientific evidence Long history (30 yrs): moderate effect sizes Senior & middle managers tend to benefit more thanmanagers at the supervisory level Effect on ‘poor’ leaders is limited. Leadership trainings that focus on interpersonal / socialskills show higher effect sizes than those based on aspecific leadership ‘model’
Questions / projects 360 degree feedback Financial incentives Lean Six Sigma Hand Hygiene Goal setting Value Based Health Care Downsizing
Evidence-based perspectiveNOT: What works?BUT: What are, given the target group, the problemand the context involved, the main factorsdetermining the success or failure of the projectthat need to be taken into account?
Multi Source Feedback: background IFMS: based on multi source feedback Regulating bodies and insurance companies(KPI’s – prices/ revenue) Based on CANMEDS, no standard method New market: consulting firms
Process Scoping session: inventory of the aspects relevantto the question Session with leading academic Search in relevant databases Critical Appraisal Summary / research synthesis Recommendations / guidelines
Multi Source Feedback: scientific evidence 223 primary studies on MSF, 42 relevant 6 meta analyses or systematic reviews onMSF, 3 relevant 18 meta analyses or systematic reviews on‘feedback’ or ‘performance appraisal’,5 relevant
Content of thefeedback (neg vs pos)Way of the deliveryof the feedbackInterpretation of thefeedbackPersonality of therateeFeedback orientationof the rateeType andnumber of ratersSelection ofratersRater reliablity(patients, nurses,colleagues)Type ofresponsescaleDevelopment vsperfomance appraisalOrganizationalculturePerceived proceduraljusticeMulti Source Feedback: main factors