The document discusses the steps of evidence-based practice (EBP) and formulating focused clinical questions using the PICOC framework. It provides an example where a healthcare organization is merging with a smaller organization and the board wants to know if cultural differences could impact a successful integration. Working through the PICOC framework, the document arrives at a focused question considering the population (back office employees), intervention (merger and back office integration), comparison (status quo), outcomes (economy of scale), and context (healthcare, different cultures, unequal sizes).

1. Postgraduate Course
Evidence-based management:
Formulate a focused question

2. Postgraduate Course
The 5 steps of EBP
1. 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)

3. Postgraduate Course
Asking the right question?
Effect vs Non-effect

4. Postgraduate Course
Types of questions: effect
Does it work?
Does it work better than ....?
Does it have an effect on ....?
What is the success factor for ....?
What is required to make it work ...?
Will it do more good than harm?
Effect

5. Postgraduate Course
Types of questions: non-effect
Needs: 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 / how does it work?
Economics: How much does it cost?

6. Postgraduate Course
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?

7. Postgraduate Course
 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?
Focused question?
 Does team-building work?

8. Postgraduate Course
P =Population
I = Intervention (or success factor)
C = Comparison
O = Outcome / Objectives
C = Context
Focused question: PICOC

9. Postgraduate Course
Example: merger

10. Postgraduate Course
Focused question: PICOC
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.

11. Postgraduate Course
Answerable question: PICOC
What else would you like to know?

12. Postgraduate Course
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?

13. Postgraduate Course
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).
Answerable question: PICOC

14. Postgraduate Course
P = back office employees
I = merger, integration back office
C = status quo
O = economy of scale
C = healthcare, different organizational culture, unequal
Answerable question: PICOC

15. Postgraduate Course
P =Population
I = Intervention or successfactor
C = Comparison
O = Outcome
C = Context
Focused question: PICOC
 Employee productivity?
 Job satisfaction?
 Return on investment?
 Market share?
 Organizational commitment?

16. Postgraduate Course
Does a difference in organizational culture
affect a successful integration of back-office
functions during a merger between two
healthcare organizations of unequal size?
Focused question

17. Postgraduate Course
4 sources of evidence
Use the 4 sources of evidence to
formulate sub questions