Evidence-Based PracticePostgraduate Course 1991 Medicine 1998 Education 1999 Social care, public policy 2000 Nursing 2000 Criminal justice ???? Management?
DefinitionPostgraduate Course 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: 1. The best available scientific evidence 2. Organizational facts, metrics and characteristics 3. Stakeholders’ values and concerns 4. Practitioner expertise and judgment
Het feilbare breinPostgraduate Course 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
Postgraduate Course if you’re breathe into a bag hyperventilating
Postgraduate Course 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
How 40,000 cardiologists can be wrongPostgraduate Course 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. The CAST trial revealed Excess mortality of 56/1000. By the time the results of this trial were published, at least 100,000 such patients had been taking these drugs.
Errors and Biases of Human JudgmentPostgraduate Course Doctors 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 their own professional experience! available evidence.
Problem II: false informationPostgraduate Course Half of what you learn will be shown to be either dead wrong or out-of-date within 7 years of your graduation; the trouble is that nobody can tell you which half Sackett: remember that your teachers are full of crap, just like your parents.
Evidence-based?Postgraduate Course 1. Incompetent people benefit more from feedback than highly competent people. 2. Task conflict improves work group performance while relational conflict harms it. 3. Being intelligent is a disadvantage for performing low skilled jobs.
Evidence-based?Postgraduate Course Competentie management Excellente zorg Kwaliteits management Het nieuwe werken Kennis management Magnet, Investors in People Plain Tree, Healing Environment Balanced Score Card / INK Lean / Six Sigma / TOC
Postgraduate Course Don’t be a parrot! Think critically about experience, question your assumptions, and challenge what you think you know. (Show me the evidence!)
Research designsPostgraduate Course What is the BEST car?
Research designsPostgraduate Course Which design for which question?
Twee type vragenPostgraduate Course Effect vs Non-effect
Type vraag: effectPostgraduate Course Werkt het? Werkt het beter dan ....? Effect Heeft het een effect op ....? Wat zijn de succesfactoren voor ....? Wat is nodig om het te laten werken?
Type: non-effectPostgraduate Course Needs: Wat hebben mensen nodig, waar hebben ze behoefte aan? Attitude: Wat denken of vinden mensen van ...? Experience: Wat zijn de ervaringen van mensen met ...? Prevalence: Hoeveel mensen / organisaties ....? Procedure: Hoe kunnen we .... implementeren? Explanation: Waarom werkt het? Economics: Hoeveel kost het (tijd en geld)?
Which design for which question?Postgraduate Course Explanation
What is evidence?Postgraduate Course Evidence is not the same as ‘proof’ or ‘hard facts’ Evidence can be - so strong that no one doubts its correctness, or - so weak that it is hardly convincing at all
Postgraduate Course The best available evidence = Studies with the highest internal validity Studies with the highest external validity
Internal validityPostgraduate Course 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 (confounding).
ConfoundingPostgraduate Course Confounding is the idea that a 3rd variable can distort or confuse (or confound..) a relationship between two other variables. For instance, when factor X causes disease Y, that relationship could be confounded by factor C that is associated with both factor X and disease Y. C would be an alternative explanation for the relationship observed between X and Y.
What are the confounders?Postgraduate Course 1. Shoe size & quality of handwriting 2. Body length & body weight 3. Number of storks & birth rate 4. Smoking youngsters & better lung function
Levels of internal validityPostgraduate Course 1. Were there enough subjects in the study? 2. Was a control group used? 3. Were the subjects randomly assigned? 4. Was a pretest used? 5. Was the study started prior to the intervention or event? 6. Was the outcome measured in an objective and reliable way? 6x yes = very high (A) 5x yes = high (A) 4-3x yes = limited (B) 2x yes = low (C) 1-0x yes = very low (D)
Levels of internal validityPostgraduate Course
Levels of internal validityPostgraduate Course It is shown that … It is likely that … There are signs that … Experts are of the opinion that …
Postgraduate Course Best available evidence: external validity
External validity: generalizabilityPostgraduate Course Always ask yourself to what extent the evidence is generalizable to your situation: Ecological validity: Is your organization so different from those in the study that its results may be difficult to apply? Population validity: Is your population so different from those in the study that its results may be difficult to apply?
GeneralizabilityPostgraduate Course Keep in mind: What works in one narrowly defined setting might not work in another, but some psychological principles are generalizable to all human beings.
Postgraduate Course Step 4: Turning evidence into practice