Evidence-Based Management - Research Paper Example

Evidence based management Evidence Based management Introduction Evidence based management (EBM) entails the application of the most efficient research evidence in managements’ decision making processes (Rousseau, 2006). The management applies evidence from research to make certain important decisions. The practice is more commonly used in the healthcare sector. EBM in healthcare borrows heavily from the Evidence Based Practice in medicine (Morrell, 2008). Traditionally, evidence was practiced through medicine but evolution through time made it applicable in management. Currently, various countries have made the practice an inclusive aspect in their management system in order to enhance the healthcare services through informed management decisions based on evidence. EBM advocates for the involvement of the best research findings in healthcare management. Managers are entitled with the responsibilities of choosing the most effective research to apply in the hospitals hence information on research techniques is necessary (Rousseau & McCarthy, 2007). In various healthcare systems, groups consisting of scientists and technicians are fomed to assess and establish the feasibility of a research before execution in real practice takes place. In case the recommendations from the research findings seem applicable, they are included in the process of making decisions. The paper will explore the significance of incorporating the best evidence in management. The paper will synthesize the history of EBM as presented in the currently available literature and compare its application both in healthcare and non healthcare professions. The paper will also analyze the strengths and weakness of the practice as well the challenges it faces at the implementation due to resistance by managers and other healthcare leaders opposing change. Historical backgrounds Evidence-based management (EBM) traces its origin from the EBP in medicine (Phillips, Pincus & Rego, 2003). EBP was first introduced in 1992 where it required nurses and other healthcare professional to synthesize and make use of the best evidence from research documented in literatures. Since its implementation in medicine, EBP has acquired a significant recognition from the World Health Organization (WHO) by increasing efforts to see its success (Guyatt & Rennie, 2002). Though the practice of utilizing evidence in medicine was initially applicable to medicine only, it has today extended to management in healthcare and other professions. Most professions are currently incorporating evidence in their decision making in order to boost accuracy and improve outcome of their decisions. Application of evidence in management is however more evident in the health sector as every hospital in the world seeks to improve their decision making processes. Need for use of EBM The structure of clinical practice has been relied on empirical and past experiences in its daily basis application. In contrast, huge developments in the healthcare system have changed the center of attention from empirical and experiences to basing health issues on evidence provided. The increased use of Information Technology has transformed EBM to a world project given that policy makers are in a position to access findings from various research groups available on the internet and examine them to assess their levels of proficiency (Phillips et al. 2003). In case the findings from various research centers prove to indicate consistency, the results are practical and can be incorporated in health care system. In order to reinforce EBM, different countries have been involved in various projects, which aim at fully associating decision making with evidence. For instance, approximately eleven thousand trials are receiving external support through public funds in the US (Morrell, 2008). Resistance to EBM practice by medical practitioners Efforts to promote decision making based on evidence has faced great challenges. The most notable one being resistance by leaders and managers who are opposed to change due to their personal reasons (Shortell, Rundall & Hsu, 2007). Research indicates that majority of leaders in various professions are opposed to changes due to fear that they may lose their jobs. The same problem befalls efforts to implement EBM in both healthcare and other professions. Given that implementation of EBM requires certain special knowledge of research methods and IT, managers and other health practitioners are reluctant to adopt the practice in fear that they may lose their jobs. According to Phillips et al., (2003), evidence that has been acquired from literature indicates little connection between developed and translated evidence. In addition, personal practitioners need to be appreciated for their endeavors to practice evidence based treatment in order to increase their motivation levels in pursuing further research. All Health policy makers should embrace and exercise frequent consultations in different Health sectors in order to increase the quality levels of available evidence. In addition, there should be constant training for stakeholders such as health practitioners and patients, which advocates for the significance of EBM. Continued use of EBM in healthcare The significance of basing clinical policy and medical practices on the superlative obtainable global evidence and putting the acquired knowledge into practice is being embraced in different medical sectors in the world. Earlier on, results of various researches were never implemented and were just considered theoretical (Pfeffer & Sutton, 2006). However in the current world, medical practitioners have realized the need to integrate health care provision with the best evidence available in the current literature. The need to provide quality health care and to improve patient outcomes has fueled the need for implementation of recommendations from various researches (Guyatt & Rennie, 2002). The evidence acquired from the available literature is appraised by experts in the medical field to determine their viability and ease of application in the health care provision. Evidence which the experts find relevant and applicable is then tested for ability to improve the outcomes. This paper therefore will analyze deeply the nature of evidence based practice in the global health care provisions and the gaps that exist. A good number of medical research projects that have been sponsored by healthcare departments are internationally recognized. They conduct research on a global scale in order to enhance uniformity in the implementation of EBM among various countries. On the contrary, the implementation of the EBM in individual countries has showed consistent variation from country to country (Shortell et al. 2007). The local implementation of EBM has greatly depended on domestic customs, the perspectives of different patients to healthcare system and technological structure in individual countries. For instance, in the US, most of the emphasis has focused on individual decisions. Technology and innovations have characterized the perception of American EBM. EBM is administered differently in various countries; in a number of countries, great emphasis has focused on collecting evidence before the approval of supply of drugs. The approach has only created efficiency but has conversely denied the patients the privilege of making choices on the type drugs to purchase since there is limitation of the availability of drugs and also indicate high levels of similarity. In the US for example, all the drugs penetrating the market have to be thoroughly scrutinized on the basis of evidence before being approved. UN is among the few world organizations where evidence is highly valued in health care. EBP initially began in the 1990s in medicinal field when the region realized it was spending a huge amount of finance to purchase drugs than it was necessary. Evidence based practices in the UN is based on the Millennium Development Goals, whose objectives is to call for nurses to act with maximum care and apply innovation techniques in delivery of their services (Phillips et al. 2003). The application of using evidence in decision making processes in the nursing field is a highly practice. The application of using evidence is believed to enable nurses to prepare well detailed questions to acquire informed decisions and deliver high quality treatment at a lower cost. In order to enhance decision making process, a computerized system is used to record information for each individual since computers eliminate biasness and are free from human errors. It is emphasized for the nurses to apply research from literature materials that are easily available so as to ensure health care services delivered are of high quality. In addition, nurses are entitled with the responsibilities of providing information concerning the patients to the policy makers. Consequently, the delivered information is collected in the different treatment processes and is then recorded through technological means so as to help in future decision making processes. Even though nurses have been accredited in for the effective use of applying evidence for treatment purposes, there still exists a gap in obtaining the required evidence and its application during treatment, which has been evidenced by the high treatment costs in the region (Shortell et al., 2007). United States has strategized through using effective techniques with the aim of reducing the costs of Medicare by a percentage of about 30% (Pfeffer & Sutton, 2006). This has been witnessed through the establishments of initiated projects, which will work at improving evidence based practices. The main objective, through HIT is to ensure that health care sector is assisted during the selection of the most appropriate treatment methods in contrast with the replacements of health judgments. EBM has implemented a number of tools that have been used in the evaluation of information such as peer reviewed articles and systematic reviews, which have proved effective in provision of reliable information. The common outcomes examined are death, disability and discomfort after treatment. EBM today uses quantitative and qualitative methods to acquire the best evidence and knowledge to be incorporated during treatment (Guyatt & Rennie, 2002). In the UK, The National Institute for Clinical Excellence (NICE) was established to offer advice to the National Health Service (NHS), a body charged with the responsibility of creating policies (Kitson, Harvey & McCormack, 1998). NICE analyzes results of different research and offers guidelines regarding cost reduction, effectiveness of various treatments and patients’ safety. Significance of EBM in nursing Efficiency The use of evidence in nursing has been an effective approach in improving the results of nursing practices. The nurses have used the information available from the evidence in making decisions that concern the type of care to be given to a patient. The effectiveness has been boosted in a number of ways such as nurses are easily able to make quick decisions on the most appropriate treatment to give to a patient (Pfeffer & Sutton, 2006). In addition, it has enabled nurses to gain confidence during delivery of treatment because they are certain on the outcome of the treatments given. It has enabled the nursing professionals to work with effective methods based on evidence present instead of trying out new unapproved methods whose outcomes cannot be ascertained. The process of making decisions in a quick manner and the ability to predict the outcomes of the treatments given has saved on time management during nursing; hence, nurses can use the additional time to attend to other patients. In addition, EBM has ensured that nurses stay innovative and have up-to-date information concerning new treatment methods that are available (Kitson et al. 1998). EBM has also provided a chance for the nurses to engage more in reading in order to expand their scope of knowledge in the nursing field in order to equip them with relevant skills for future decision making nursing situations. As such, EBM has equipped nurses with a platform where they can be able to make informed decisions hence improving the overall healthcare services (Reynolds, 2008). Better Patient Outcome As previously stated, the practical approach of using evidence has led to the improvement of health care and enhancing predictability in assessing outcomes (Shortell et al. 2007). EBM adopts the most recent research evidence available from literature and provides the latest changes made in the applications of nursing. The findings from medical researches carried out have proved to be reliable and different research results have been used to examine consistency in order to ascertain credibility of the outcomes. As such, using the research findings as the basis for delivery of treatments have proved to be effective, in addition to providing nurses with additional knowledge, which they can use in making informed decisions. In addition, EBM upholds the value of implementing recommendations that have been obtained from research. Consequently, the recommendations can be used to improving nursing skills hence enhancing the overall quality of healthcare given to the patients. During the line of duty, nurses are required to make crucial decisions, which have a high impact on a patient’s health outcome. When such crucial decisions are based on approved research, issues such as trial and errors are eliminated, which also ensures that the patient is offered the best medical treatment available, hence outcomes can be predicted. EBP issues Although EBM has been embraced in a number of countries, a number of factors have hindered the implementation of this medical approach. The scarce availability of resources is among the major factors that have hindered the incorporation of EBM. The medical approach is being carried out effectively in developed countries although its implementation in developing countries has encountered various challenges hence declining its impact due to lack of relevant skills and resources. Other factors are cultures and illiteracy that befall most developing countries. Although the use of accurate and credible data has assisted health care professionals in choosing the less costly drugs, thus low cost of Medicare, EBM faces more challenges. The scarcity of technological infrastructure in the health care has caused delays in formulation of policies and crucial medical decisions. EBM application in Australia Research indicates that cigarette smoking accounts for up to 19,000 of annual deaths in Australia (Pfeffer & Sutton, 2006). Majority of these deaths result from cancer, a disease believed to be caused by smoking. Research further shows that more than 66% of long-term smoking addicts are more prone to tobacco related diseases (Guyatt & Rennie, 2002). The problem is compounded by the fact that tobacco has high addiction aspect hence long-term users of tobacco face difficult challenges in overcoming the addictive practice. Cessation is a continuous process, which entails constant active interaction between health practitioners and the affected victims. As such, medical professionals in Australia have implemented evidence based practices in order to prevent deaths resulting from tobacco related problems. The country’s healthcare system has established practice guidelines in order to reduce the number of addicted users (Shortell et al. 2007). The practitioners have implemented the 5A framework that incorporates the procedures involved in curbing smoking addiction. The framework encourages nurses to enquire from the patient on their experience and documentation of the interviews as evidence. The interest of the smoker to quit smoking is rated on a scale of 1-10 where 10 represents very high interest while 1 represents poor interest (Pfeffer & Sutton, 2006). Under the framework, Patients are also assessed on their daily consumption and presence of withdrawal symptoms in the first cessation attempt. Nurses are also obliged to assess the smoker’s previous attempts to quit and discuss pharmacotherapy treatment with the patient (Rosenberg & Donald, 1995). The nurses have recognized the significance of implementing a systematic approach so as to assist smoking addicts in recovering from the habit. They facilitate enquiry routines as well as carry out various surveys in the waiting bay in order to obtain relevant knowledge, which is incorporated with Australia’s EBP (McMillan & Schumacher, 2014). Most of the medical practitioners depend on evidence, which is only available in literary form that campaigns for provision of counseling sessions to smoking by the practitioners (Gray, 2001). Among the many effective services that the nurses provide in tackling the smoking problem, nurses also evaluate the victim’s willingness to quit smoking and offer other self help materials. In addition, the nurses also enlighten victims on the positive benefits that an individual gains after overcoming smoking addiction. A great number of tobacco users is unable to successively quit tobacco addiction in their first attempt due to the substance’s addictive property. Nonetheless, the health professionals always encourage the addicted users to continually try in overcoming the habit. Application of EBM in non health professions Contrary to the past where EBM was only applicable in the healthcare, it is now being applied in other industries and professions (Simonsen et al. 2008). EBP is largely being applied in the software development industry as a tool of increasing efficiency. The practice is also being applied in other fields such as crime prevention, public and human resource management as well applied in the healthcare industry than in other profession. The software development sector has in the recent past experienced a growth in EBM (Shortell et al. 2007). The sector is utilizing current evidence to improve decision making regarding software development and maintenance. The education sector has in the recent past embraced the use of evidence in their management (Manchikanti et al 2008). Institution managers are extracting the best evidence from scientific researches and incorporating it in the management in hope to improve the outcome. However unlike EBM in healthcare, use of evidence in the education sector has criticized since it is based on a number of factors viz. the teaching style, personality and beliefs that makes its implementation quite a hard task (Morrell, 2008). In healthcare, a specific drug is tested for its effectiveness in management of a certain ailment and practical results are obtained. In education, such evidence may not be easy to obtain due to the aforementioned variables that have the ability to influence the outcomes. Why nurses need to understand research methods in order to implement evidence-based practice There are 2 commonly used research methods in nursing application; the qualitative and the quantitative research methods (Guyatt & Rennie, 2002). The qualitative method applies the use of direct interviews and oral analysis during collection of information on a particular phenomenon while the qualitative method applies the use of generalization of the findings from the analysis (Jadad et al., 2000). Explicit information concerning the mentioned methods above are discussed below in details. Firstly, nurses are required to choose a single research to incorporate from the numerous resources in literature (Shortell et al., 2007). The results are first evaluated and analyzed to select the most relevant evidence that can be used in the EBP before they are incorporated. The process of determining the most applicable research in healthcare entails vast amount of knowledge by the nurses concerning the available research techniques. A small sample research is carried out hence the findings obtain only represent little data presentation, which cannot be used due to unreliability since it does not also meet implementation threshold (Ellrodt et al., 1997). Nurses therefore have to be equipped with relevant knowledge in order to evaluate and establish the practicality of the research. In addition, it is the responsibility of the nurses to collect information from patients through interviewing them. They ought to possess the required knowledge to be able to extract such information and assess the reliability of such evidence. Nurses are required to be equipped with relevant knowledge so as to be in a position to effectively obtain necessary information and ascertain the credibility of the evidence obtained. The process of assessing the best evidence to incorporate in EBP requires the nurses to apply a technique called research utilization (Rousseau, 2006). Research utilization is a subdivision of quantitative technique hence knowledge concerning this analysis method is mandatory for every nurse. This method is applied when selecting the best research from various researches available in literature form (Pfeffer & Sutton, 2006). As such, nurses apply this method when selecting the most appropriate research evidences to be used in supporting data collection as well as the assessment of quality and the outcome in patients. Conclusion EBP entails the implementation of the best research evidence in decision making regarding management. The emergence of the practice was due to the need of a more effective approach that would be used in enhancing delivery of health care services in the nursing field. Evidence has become an essential aspect in research, which has led to the development of adopting of EBM in different countries through increasing resources and relevant skills to the health sector. Although the management practice has been effective in a number of developing countries, the rate of establishment in developing countries has been slow due to scarce availability of relevant resources as well as the respective skills need in adopting the approach. On the other hand, it has been the role of the nurses to ensure that the practice of EBM is effective in its implementation since they play a critical role in ensuring that the well-being of a patient is maintained as well as providing the best health care services. Today, EBM has penetrated other professional fields such as education, crime prevention among others. 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