Evidence Based Healthcare Management


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  • … . (continues from previous slide) are applied to decisions regarding business processes, operations, or strategic planning in order improve the performance of the organization. EBHSM encourages managers to base their decisions on well-conducted management studies whenever possible. If these studies do not exist on your topic, then make use of other sources of information, such as personal experience, experiences of others in other situations, existing data, etc. Supplementary: Evidence based health services management applies the idea of evidence-based decision making to business process, operational, and strategic decisions in health services organizations. Whenever possible, health services managers should incorporate evidence into their decision making from well conducted management research studies. However, other sources of information and knowledge, such as personal experience, experiences of others in similar situations, expert opinion, and simple inspection of data trends and patterns, can and should be used if such information is the best available evidence for a given decision.   “ Simply put, EBHSM is the systematic application of the best available evidence to the evaluation of managerial strategies for improving the performance of health services organizations ” (Kovner & Rundall, 2006, p. 6). This approach recognized that decision making is a process rather than a simple act of choosing among alternatives . 0:08 (1)
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  • Evidence Based Healthcare Management

    1. 1. Linking Hospital Managers to the Literature: An Evidence-based Approach ROBIN FEATHERSTONE April 14, 2011
    2. 2. Your Information Seeking Behaviour
    3. 3. Origins of the Evidence-based Movement <ul><li>1990s: David Sackett et al. from McMaster coined the term, Evidence-based Medicine (EBM) </li></ul><ul><li>Aimed to improve the quality of information used to make decisions </li></ul><ul><li>Migrated to other sectors - dentistry, nursing, management, etc. </li></ul>
    4. 4. What is Evidence-based Health Services Management (EBHSM)? <ul><li>Aids in the decision-making process </li></ul><ul><li>Incorporates quality evidence from the literature </li></ul><ul><li>Seeks to evaluate managerial strategies and improve the performance of health services organizations </li></ul><ul><li>(Kovner & Rundall, 2006) </li></ul>
    5. 5. Today ’s Objective <ul><li>learn to search for the best quality information to practice evidence-based decision-making in hospital management </li></ul>
    6. 6. How Questions Influence Search Results Relevancy Retrieval (# of search results) Broad Questions Narrow Questions High = lots of articles Low = very few articles High = directly relevant articles Low = mostly irrelevant articles
    7. 7. Guidelines for Formulating a Question <ul><li>1- What management tool/technique are you thinking of using? </li></ul><ul><li>2- What process or outcome do you wish to achieve? </li></ul><ul><li>3- What is the setting? </li></ul>(Kovner & Rundall, 2006)
    8. 8. <ul><li>How do interdisciplinary teams function? </li></ul><ul><li>What workplace conditions are necessary to support collaboration among members of interdisciplinary teams? </li></ul>From Thought to Question
    9. 9. Exercise – 5 minutes <ul><li>In pairs, develop a narrow question based on the following topics: </li></ul><ul><li>“ Transforming Care at the Bedside ” </li></ul><ul><li>Patient flows </li></ul>
    10. 10. Levels of Evidence Pyramid Level 3: Single site studies Level 4: Descriptive studies/Case Reports Level 5. Expert Opinion More Time More Work More Evidence Level 1: Systematic Reviews of Randomized Controlled Trials Level 2: Multicenter/Comparative studies Less Time Less Work Less Evidence UNFILTERED FILTERED
    11. 11. Cochrane Library - DEMO Contents Cochrane Reviews -Approx. 4000 full-text reviews -Therapy, prevention and diagnosis information Other Reviews -Approx. 16,000 abstracts -International coverage -Covers effects of clinical interventions Clinical Trials -Approx. 600,000 summaries of ongoing or completed clinical trials -International coverage Methods Studies -Summaries of reports of methods used in clinical trials Technology Assessments -Abstracts of studies assessing health care technologies Economic Evaluations -Abstracts and brief records of studies looking at costs and effects of competing healthcare interventions
    12. 12. Exercise <ul><li>Search the Cochrane Library to answer the question: </li></ul><ul><li>What are effective methods for increasing patient participation in clinical decision making? </li></ul>
    13. 13. Medline via PubMed - DEMO <ul><li>produced by the National Library of Medicine (U.S.) </li></ul><ul><li>indexes 5,500+ journals in the health sciences </li></ul><ul><li>provides references and abstracts to journal articles </li></ul>UNFILTERED FILTERED
    14. 14. Using Subject Headings <ul><li>Search each concept in your question separately </li></ul><ul><li>Mapping each of your concepts to a subject heading will find: </li></ul><ul><ul><li>the preferred search term in the database </li></ul></ul><ul><ul><li>articles about your topic </li></ul></ul><ul><li> </li></ul>
    15. 15. Exercise <ul><li>Find articles that discuss procedures for patient admissions from the ER </li></ul><ul><li>Tip : Break down the question into its separate concepts before searching. </li></ul>
    16. 16. What is the MeSH term for: <ul><li>Patient admissions? </li></ul><ul><li>Emergency room? </li></ul><ul><li>Procedures? </li></ul>
    17. 17. Subheadings <ul><li>Use to investigate specific aspects of your topic </li></ul><ul><li>Narrows your search e.g., Patient Admission = ~15,600 results Patient Admission/methods = ~8 results </li></ul><ul><li>Frequently used subheadings for management topics: /economics , /methods , /organization & administration , /statistics & numerical data </li></ul>
    18. 18. Combining search terms <ul><li>OR related terms for an individual concept; increases your search results e.g., tertiary care hospitals OR university teaching hospitals </li></ul><ul><li>AND two/more concepts together to find relevant articles; decreases your search results e.g., re-engineering of jobs AND health care services </li></ul><ul><li>PubMed DEMO: Find articles that discuss procedures for patient admissions from the ER </li></ul>
    19. 19. Applying limits <ul><ul><li>Language </li></ul></ul><ul><ul><li>Year </li></ul></ul><ul><ul><li>Age group </li></ul></ul><ul><ul><li>Publication Type, etc. </li></ul></ul>
    20. 20. Exercise <ul><li>What are the costs involved to support teaching activities in a university teaching hospital? </li></ul>
    21. 21. 15 minute break
    22. 22. Principles of Online Searching <ul><li>Define your question. </li></ul><ul><li>Break down the question into its separate concepts. </li></ul><ul><li>Search each concept separately. </li></ul><ul><li>Combine search terms (AND/OR). </li></ul><ul><li>Apply limits. </li></ul><ul><li>Evaluate your results. </li></ul><ul><li>Modify your search strategy if necessary. </li></ul>
    23. 23. Exercise <ul><li>Does organizational culture impact patient safety management? </li></ul>
    24. 24. About PubMed HSR Queries Filter <ul><li>An automated method to filter your PubMed search </li></ul><ul><li>Limits your results to studies about health care quality and costs - Appropriateness of care - Process assessment - Outcome assessment - Costs - Economics - Qualitative research </li></ul>UNFILTERED FILTERED
    25. 25. Applying the HSR Queries Filter to your PubMed Search <ul><li>Copy your PubMed search strategy. </li></ul><ul><li>Go to PubMed ’s homepage. </li></ul><ul><li>Click on the “Topic-Specific Queries” link. </li></ul><ul><li>Click on the “Health Services (HSR) Queries” link. </li></ul><ul><li>Paste your PubMed search strategy in the search box. </li></ul>
    26. 26. About ProQuest Databases <ul><li>Contains: </li></ul><ul><li>Business references (ABI/INFORM, CBCA, Research Library) </li></ul><ul><li>Company profiles (Hoover ’ s) </li></ul><ul><li>News sources (Canadian Newstand) </li></ul><ul><li>Government and Industry Reports (Canadian Research Index) </li></ul>UNFILTERED FILTERED
    27. 28. ProQuest Databases – Demo
    28. 29. Exercise <ul><li>Go to http://muhclibraries.mcgill.ca/adminguide.php . In pairs, search ProQuest Databases to answer the questions: </li></ul><ul><li>Does the implementation of “ Transforming Care at the Bedside ” impact on job satisfaction? </li></ul><ul><li>Who are Sodexo, Inc. ’ s main competitors? </li></ul>
    29. 30. Summary <ul><li>What resources will help you to find: </li></ul><ul><ul><li>Systematic Reviews of RCTs? </li></ul></ul><ul><ul><li>Process assessments? </li></ul></ul><ul><ul><li>Company profiles? </li></ul></ul><ul><ul><li>Newspaper articles? </li></ul></ul>
    30. 31. <ul><li>Where would you place the following resources on the pyramid? </li></ul><ul><li>PubMed </li></ul><ul><li>Cochrane Library </li></ul><ul><li>ProQuest </li></ul><ul><li>HSR Queries filter </li></ul>Summary cont ’ d. UNFILTERED FILTERED
    31. 32. Useful References on EBHSM <ul><li>Reay T, Berta W, Kohn MK. What's the evidence on evidence-based management? Academy of Management Perspectives . 2009;23(4):5-18. </li></ul><ul><li>Rousseau DM, McCarthy S. Educating managers from an evidence-based perspective. Academy of Management Learning & Education . 2007;6(1):84-101. </li></ul><ul><li>Kovner AR, Rundall TG . Evidence-based management reconsidered. Frontiers of Health Services Management . 2006;22(3):3-22. </li></ul><ul><li>Chan KS, Morton SC, Shekelle PG. Systematic reviews for evidence-based management: how to find them and what to do with them. American Journal of Managed Care . 2004;10(11 Pt 1):806-12. </li></ul><ul><li>Walshe K, Rundall TG. Evidence-based management: from theory to practice in health care. Milbank Quarterly . 2001;79(3):429-57. </li></ul>