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Evidence-Based Heathcare Logistisc

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Presentation Evidence-Based Heathcare Logistics
Erasmus University Oct 13, 2011
Eric Barends

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Evidence-Based Heathcare Logistisc

  1. 1. Evidence-Based ManagementWhat is it?Why do we need it?How does it look like in practice?<br />Congres Evidence-Based Zorglogistiek, 13 oktober 2011<br />
  2. 2. Postgraduate Course<br />Evidence based management:<br />What is it?<br />
  3. 3. Definition<br />Evidence-based management means making decisions about the management of employees, teams or organizations through the conscientious, explicit and judicious use of four sources of information:<br />1. The best available scientific evidence<br />2. Organizational facts, metrics and characteristics<br />3. Stakeholders’ values and concerns<br />4. Practitioner expertise and judgment<br />
  4. 4. Four sources<br />
  5. 5. What is evidence?<br />Postgraduate Course<br />Evidence is not the same as ‘proof’ or ‘hard facts’<br /> Evidence can be<br /> - so strong that no one doubts its correctness, or<br /> - so weak that it is hardly convincing at all<br />
  6. 6. Medicine: Founding fathers<br />Postgraduate Course<br />David Sackett<br />Gordon Guyatt<br />McMaster University Medical School, Canada<br />
  7. 7. Management: Founding Mother<br />Postgraduate Course<br />
  8. 8. Management: Founding Fathers<br />Postgraduate Course<br />Robert Sutton<br />Jeffrey Pfeffer<br />
  9. 9. Postgraduate Course<br />2. Evidence-based management:<br />Why do we need it?<br />
  10. 10. EBMgt: some basic assumptions<br />Postgraduate Course<br /><ul><li>Research produced by management scholars could be useful to organizations
  11. 11. Drawing on available evidence (including research produced by academics) is likely to improve decisions
  12. 12. Organizations do not appear to be strongly aware of nor use research findings
  13. 13. EBMgt is a potentially useful way of thinking about how we can incorporate research evidence into decision-making</li></li></ul><li>Postgraduate Course<br />Reason 1:<br />Errors and Biases of Human Judgment <br />
  14. 14. Errors and Biases of Human Judgment <br />Postgraduate Course<br /><ul><li>Seeing order in randomness
  15. 15. Mental corner cutting
  16. 16. Misinterpretation of incomplete data
  17. 17. Halo effect
  18. 18. False consensus effect
  19. 19. Reinterpreting evidence
  20. 20. Group think
  21. 21. Confirmation bias
  22. 22. Authority bias
  23. 23. In-group bias
  24. 24. Recall bias
  25. 25. Anchoring bias
  26. 26. Inaccurate covariation detection
  27. 27. Distortions due to plausibility</li></li></ul><li>Errors and Biases of Human Judgment <br />Postgraduate Course<br /><ul><li>Seeing order in randomness
  28. 28. Mental corner cutting
  29. 29. Misinterpretation of incomplete data
  30. 30. Halo effect
  31. 31. False consensus effect
  32. 32. Reinterpreting evidence
  33. 33. Group think
  34. 34. Confirmation bias
  35. 35. Authority bias
  36. 36. In-group bias
  37. 37. Recall bias
  38. 38. Anchoring bias
  39. 39. Inaccurate covariation detection
  40. 40. Distortions due to plausibility</li></li></ul><li>Seeing order in randomness<br />Postgraduate Course<br />We are predisposed to see order, pattern and causal relations in the world.<br />Patternicity: The tendency to find meaningful patterns in both meaningful and meaningless noise.<br />
  41. 41. Seeing order in randomness<br />Postgraduate Course<br />We are patern seeking primates: association learning<br />
  42. 42.
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  44. 44.
  45. 45.
  46. 46.
  47. 47.
  48. 48.
  49. 49.
  50. 50. Points of impact of V-1 bombs in London <br />Postgraduate Course<br />
  51. 51. Points of impact of V-1 bombs in London <br />Postgraduate Course<br />
  52. 52. Errors and Biases of Human Judgment <br />Postgraduate Course<br /><ul><li>A Type I error or a false positive, is believing a pattern is real when it is not (finding a non existent pattern)
  53. 53. A Type II error or a false negative, is not believing a pattern is real when it is (not recognizing a real pattern)</li></ul>Dr. Michael Shermer (Director of the Skeptics Society)<br />
  54. 54. Errors and Biases of Human Judgment <br />Postgraduate Course<br /><ul><li>A Type I error or a false positive: believe that the rustle in the grass is a dangerous predator when it is just the wind (low cost)</li></li></ul><li>Errors and Biases of Human Judgment <br />Postgraduate Course<br /><ul><li>A Type II error or a false negative: believe that the rustle in the grass is just the wind when it is a dangerous predator (high cost)</li></li></ul><li>Errors and Biases of Human Judgment <br />Postgraduate Course<br />Pattern detection problem<br />Assessing the difference between a Type I and Type II error is highly problematic (especially in split second ‘life and death’ situations), so the default position is to assume all patterns are real.<br />
  55. 55. Errors and Biases of Human Judgment <br />Postgraduate Course<br />Jennifer Whitson, University of Texas Austin, corporate environments<br />
  56. 56. Errors and Biases of Human Judgment <br />Postgraduate Course<br />Erroneous beliefs plaque both experienced professionals and less informed laypeople alike.<br />stress<br />peptic ulcer<br />
  57. 57. Oct 2005<br />Peptic ulcer – an infectious disease!<br />This year's Nobel Prize in Physiology or Medicine goes to Barry Marshall and Robin Warren, who with tenacity and a prepared mind challenged prevailing dogmas. By using technologies generally available (fibre endoscopy, silver staining of histological sections and culture techniques for microaerophilic bacteria), they made an irrefutable case that the bacterium Helicobacter pylori is causing disease. By culturing the bacteria they made them amenable to scientific study.<br />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 now<br /> firmly established that Helicobacter pylori causes more then 90% of duodenal ulcers. The link between Helicobacter pylori infection and peptic ulcer disease has been established through studies of human volunteers, antibiotic treatment studies and epidemiological studies.<br />
  58. 58. Errors and Biases of Human Judgment <br />Postgraduate Course<br />Doctors, teachers, lawyers and managers hold many erroneous beliefs, not because they are ignorant or stupid, but because they seem to be the most sensible conclusion consistent with the available evidence. <br />They hold such beliefs because they seem to be the irresistible products of their own professional experience.<br />They are the products, not of irrationality, but of flawed rationality <br />
  59. 59. Errors and Biases of Human Judgment <br />Postgraduate Course<br /><ul><li>Seeing order in randomness
  60. 60. Mental corner cutting
  61. 61. Misinterpretation of incomplete data
  62. 62. Halo effect
  63. 63. False consensus effect
  64. 64. Reinterpreting evidence
  65. 65. Group think
  66. 66. Confirmation bias
  67. 67. Authority bias
  68. 68. In-group bias
  69. 69. Recall bias
  70. 70. Anchoring bias
  71. 71. Inaccurate covariation detection
  72. 72. Distortions due to plausibility</li></li></ul><li>Group think: management fads<br />Postgraduate Course<br />The nearly-forgotten fads:<br /><ul><li>Scientific Management/Taylorism
  73. 73. Business Process Reengineering
  74. 74. Management by results
  75. 75. Excellence
  76. 76. Total Quality Management
  77. 77. Learning Organizations
  78. 78. Knowledge Management</li></li></ul><li>Group think: management fads<br />Postgraduate Course<br />The fads that haven’t been forgotten (yet):<br /><ul><li>Talent management
  79. 79. Management development
  80. 80. Executive coaching
  81. 81. Emotional intelligence
  82. 82. Employee engagement
  83. 83. Knowledge management
  84. 84. Myers Briggs Type Indicator
  85. 85. Belbin Team Roles</li></li></ul><li>Group think: management fads<br />Postgraduate Course<br />“And there we see the power of any big managerial idea (or fad). It may be smart, like quality, or stupid, like conglomeration. Either way, if everybody's doing it, the pressure to do it too is immense. If it turns out to be smart, great. If it turns out to be stupid, well, you were in good company and most likely ended up no worse off than your competitors. Your company's board consists mostly of CEOs who were probably doing it at their companies. How mad can they get?<br />
  86. 86. Group think: management fads<br />Postgraduate Course<br />The true value of conventional management wisdom is not that it's wise or dumb, but that it's conventional. It makes one of the hardest jobs in the world, managing an organization, a little easier. By following it, managers everywhere see a way to drag their sorry behinds through another quarter without getting fired. And isn't that, really, what it's all about?”<br />(Colvin, 2004, Fortune)<br />
  87. 87. Postgraduate Course<br />So?<br />
  88. 88. Errors and Biases of Human Judgment <br />Postgraduate Course<br /><ul><li>Managers seem to be extremely good at generating ideas, theories, and explanations that have the ring of plausibility. They may be relatively deficient, however, in evaluating and testing those ideas once they are formed.
  89. 89. This requires that we think critically about experience, question our assumptions, and challenge what we think we know
  90. 90. (Show me the evidence!)</li></li></ul><li>Postgraduate Course<br />Reason 2:<br />De ‘buitenwereld’ wordt steeds kritischer<br />
  91. 91. Probleem2: kritischegeluiden<br />Postgraduate Course<br />“Managers maken Nederland ziek ... Steeds meer vakmensen (zoals docenten, verpleegkundigen, artsen) hebben het gevoel dat ze worden aangestuurd door managers die van het vak geen verstand hebben maar wel de dienst uitmaken.”<br />Ad Verbrugge<br />
  92. 92. Probleem2: kritischegeluiden<br />Postgraduate Course<br />“Of het nu gaatomeenziekenhuis of eendropfabriek, teveel managers hebben de pretentiedatzealleskunnenmanagenzonderook maar teletten op de inhoud van het werk. Het zijnfiguren die alseenvlo van de ene "uitdaging" naar de anderespringen, een spoor van verbittering en vernielingachterzichlatend.”<br />Geert Mak<br />
  93. 93. Probleem2: kritischegeluiden<br />Postgraduate Course<br />“Nog meer managers, nog meer reorganisaties, nog meer power point-presentaties, nog meer holle retoriek over topprestaties en topkwaliteit. De groeiende korst van nepfuncties die onze bedrijven, scholen en andere organisaties nutteloos belasten wordt almaar dikker .”<br />Dorien Pessers<br />
  94. 94. Brede maatschappelijke ontwikkeling<br />Postgraduate Course<br />
  95. 95. Brede maatschappelijke ontwikkeling<br />Postgraduate Course<br /> “Waar de overheid, de dokter, de pedagoog en de manager vroeger een eenvoudig beroep op hun autoriteit konden doen, zullen zij nu met getallen en statistiek hun gelijk moeten aantonen.”<br />
  96. 96. Brede maatschappelijke ontwikkeling<br />Postgraduate Course<br /> Evidence basedmedicine<br /> Evidence basededucation<br /> Evidence basedcriminology<br /> Evidence basedsocialwelware<br /> Evidence based management?<br />
  97. 97. Postgraduate Course<br />Evidence based management:<br />How does it look like in practice?<br />
  98. 98. Four sources<br />
  99. 99. JAMA, 1992<br />
  100. 100. Push vs Pull<br />Push: teaching (management) principles based upon a convergent body of research and telling students what to do.<br />Pull: teaching (managers) how to find, appraise and apply the outcome of research (evidence) by themselves<br />
  101. 101. The 5 steps of ‘pull’ EBP<br />Formulate an answerable question<br /> Search for the best available evidence<br /> Critically appraise the evidence<br /> Integrate the evidence with your managerial expertise and organisational concerns and apply<br /> Monitor the outcome<br />
  102. 102. The 5 steps of ‘pull’ EBP<br />Formulate an answerable question<br />Search for the best available evidence<br /> Critically appraise the evidence<br /> Integrate the evidence with your managerial expertise and organisational concerns and apply<br /> Monitor the outcome<br />
  103. 103. Answerable question<br />Postgraduate Course<br />I am a consultant, my client a large health-care organization. The board of directors has plans for a merger with a smaller healthcare organization. However, it’s been said that the organizational culture differs widely between the two organizations. The board want’s to know if this can impede a successful outcome.<br />
  104. 104. Answerable question: PICO(C)<br />Postgraduate Course<br />P= Population or problem<br />I = Intervention or successfactor<br />C= Comparison<br />O= Outcome<br />C = Context<br />
  105. 105. Answerable question: PICOC<br />Postgraduate Course<br />P: What kind of Population are we talking about? Middle managers, back-office employees, medical staff, clerical staff? <br />O: What kind of Outcome are we aiming for? Employee productivity, return on investment, profit margin, competitive position, innovation power, market share, customer satisfaction? <br />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? <br />
  106. 106. The 5 steps of ‘pull’ EBP<br />Formulate an answerable question<br />Search for the best available evidence<br />Critically appraise the evidence<br /> Integrate the evidence with your managerial expertise and organisational concerns and apply<br /> Monitor the outcome<br />
  107. 107. Where do we search?<br />Postgraduate Course<br />
  108. 108. How do we search?<br />Postgraduate Course<br />
  109. 109. The 5 steps of ‘pull’ EBP<br />Formulate an answerable question<br /> Search for the best available evidence<br /> Critically appraise the evidence<br />Integrate the evidence with your managerial expertise and organisational concerns and apply<br /> Monitor the outcome<br />
  110. 110. Critical appraisal<br />Postgraduate Course<br />How to read a research article?<br />
  111. 111. Critical appraisal<br />Postgraduate Course<br />Study designs<br />Levels of evidence<br />Bias / confounding<br />Effect sizes<br />External validity<br />
  112. 112. Research designs<br />Which study for which question?<br />The “best” evidence depends on the question type !<br />
  113. 113. Levels of evidence<br />
  114. 114. The 5 steps of ‘pull’ EBP<br />Formulate an answerable question<br /> Search for the best available evidence<br /> Critically appraise the evidence<br />Integrate the evidence with your managerial expertise and organisational concerns and apply<br /> Monitor the outcome<br />
  115. 115. Organization concerns<br />Always ask yourself to what extent the evidence is applicable in your situation:<br /> Is your organization / division / population so different from those in the study that its results cannot apply?<br /> How relevant is the study to what you are seeking to understand or decide? <br />What are your organization’s potential benefits and harms from the intervention?<br /> Is the intervention feasible in your setting?<br />
  116. 116. The 5 steps of ‘pull’ EBP<br />Formulate an answerable question<br /> Search for the best available evidence<br /> Critically appraise the evidence<br /> Integrate the evidence with your managerial expertise and organisational concerns and apply<br />Monitor the outcome<br />
  117. 117. Monitor the outcome<br /><ul><li>Uitkomst gemeten?
  118. 118. Voormeting?
  119. 119. Controlegroep?</li></li></ul><li>Do a trial!<br />
  120. 120. Monitor the outcome<br /><ul><li>Business ProcessRedesign?
  121. 121. Six Sigma?
  122. 122. Lean management?
  123. 123. Lean Six Sigma?
  124. 124. TOC/ Theory of Constraints?
  125. 125. Performance Management?
  126. 126. Of …..</li></li></ul><li>Vragen?<br />

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