EVIDENCE-BASED MANAGEMENT

DECISION-MAKING: IS IT A POSSIBILITY
IN HEALTHCARE MANAGEMENT?
- By Prof. Rahul Sharma

Crucial to finding the way is this:

there is no beginning or end.
You must make your own map.
Joy Harjo
A Map to the Next World: Poems

REFLECTIONS

Setting the Context relating Evidencebased Decision-Making

What is Evidence?
Cautions related to Status of Evidencebased Decision-Making
Your Roles as Leaders and Champions

APPROACHES TO EVIDENCE

Decision-makers
=
evidence
viewed
colloquially, anything that establishes a
fact or gives reason for believing
something, defined by relevance
Researchers
=
evidence
viewed
scientifically, use of systematic and
replicable methods for production, defined
by methodology
Emphasis on context-free universal truths
(evidence based medicine)
Emphasis
on
context-sensitive
role
for
evidence in particular decision (applied social
science)

WHO DEFINIITON
EVIDENCE

OF

Findings from research and other

knowledge that may serve as a
useful basis for decision-making in
public health and health care.

-World Health Organization Europe (2004)

UK GOVERNMENT
OF EVIDENCE

DEFINITION

The raw ingredient of evidence is information.

Good quality policy making depends on high quality
information, derived from a variety of sources
expert
knowledge;
existing
domestic
and
international
research;
existing
statistics;
stakeholder consultation; evaluation of previous
policies; new research, if appropriate; or
secondary sources, including the internet.
Evidence can also include analysis of the outcome
of consultation, costings of policy options and the
results of economic or statistical modeling.
U.K. Government Policy Hub (1999)

CHSRF DEFINITION OF
EVIDENCE
Evidence is information that comes closest to
the facts of a matter. The form it takes
depends on context. The findings of highquality, methodologically appropriate research
are the most accurate evidence. Because
research is often incomplete and sometimes
contradictory or unavailable, other kinds of
information are necessary supplements to or
stand-ins for research. The evidence base for
a decision is the multiple forms of evidence
combined to balance rigour with expedience
while privileging the former over the latter.
CHSRF (2006)

WHY EVIDENCE IS
IMPORTANT???

Improved patient health outcomes

Improved population health outcomes
Cost containment
Quality improvement
Accountability
Responsiveness in a new age
Can it work?
Will it work?
Is it worth it?

WHY
EVIDENCE
MUST
BE
INTERPRETED what, how, who

Inherent
uncertainly
usually
accompanying evidence definitive
studies rare
Complexity
of
decisions
and
improbability
of
evidence
being
comprehensive
Need for actors to create meaning and
interpret evidence before it becomes
knowledge
Evidence
is
uncertain,
dynamic,
complex, contestable, rarely complete

UNDERLYING PRINCIPLES

Accountability
Transparency
Quality
Inclusiveness
Reliability
Responsiveness
Explicitness

CATEGORIES OF EVIDENCE

Research evidence = accepted research

methodologies
Organizational evidence = information about
organizations capacity to complete the
task, e.g., human resource requirements,
availability of managerial expertise, reality
of limited budgets
Political evidence = public attitudes towards
proposed policies, media reaction
Rudolph Klein (2004)

Quality of Evidence

CATEGORIES OF EVIDENCE

Context-free scientific evidence =

medically oriented effectiveness
research
Context-sensitive scientific evidence =
social science oriented research
Colloquial evidence = expertise, views
and realities of stakeholders
Lomas, et al (2005)

CONTEXT-SENSITIVE
SCIENTIFIC EVIDENCE

Attitudes
Implementation
Organizational capacity
Forecasting
Economics/finance
Ethics

COLLOQUIAL EVIDENCE

Resources
Expert and professional opinion
Political judgment
Values
Habits and traditions
Lobbyists and pressure groups
Pragmatics
and
contingencies
situation

of

Evidence Based Decision

Patient
Preferences
Evidence
from
Research

Evidence Based
Decision

Available
Resources

Professional
Expertise

Evidence Based Decision

Making Process

DELIBERATIVE PROCESS
A deliberative process is a tool for
producing guidance based on heterogeneous
evidence. It is a participatory process that
includes representation from experts and
stakeholders, face-to-face interaction,
criteria for the sources of scientific
evidence
and
their
weight,
and
a
mechanism for eliciting colloquial evidence
while making it subsidiary to the science.
CHSRF (2006)

ARGUMENTS FOR
DELIBERATIVE PROCESSES

Eliciting and Combining Evidence

Democratic Governance
Creating Acceptable Guidance

SUCCESS OF
DELIBERATIVE PROCESSES

Presence of strong chairperson

Different types of evidence
Engagement of scientific and decisionmaking communities
Explicit process of exclusion/inclusion
Face-to-face discussions
Appropriate timelines for questions
Mechanism to elicit values of participants
Venue for expressing minority views

CAUTIONS
REGARDING
EVIDENCE
BASED DECISION-MAKING

It is early days yet for evidence-based

decision-making.
Evidence-based
decision-making
and
change management are intertwined.
Evidence is more than research in
evidence-based decision-making.
Evidence-based
decision-making
is
sustained through personal relationships.
There is need for an evidence-based
decision-making infrastructure.

INFLUENCING THE
FUTURE

Hold the vision

Know your strengths
Develop new skills/competencies
Envision creatively the ways
Build on the best
Be patient but persistent
Be collaborative but challenging