EBMgt Course Module 2: Where Does It Come From

1. Postgraduate Course
Evidence based management:
Where does it come from?

2. Postgraduate Course
 “there is a large research-user gap”
 “practitioners do not read academic journals”
 “the findings of research into what is an effective intervention
are not being translated into actual practice”
 “academics not practitioners are driving the research agenda”
 “the relevance, quality and applicability of research is
questionable”
 “practice is being driven more by fads and fashions than
research”
 “many practices are doing more harm than good”
What field is this?

3. Postgraduate Course
McMaster University Medical School, Canada
Medicine: Founding fathers
David Sackett Gordon Guyatt

4. Postgraduate Course
How it all started

5. Postgraduate Course
 More than 1 million articles in 40,000 medical journals per
year (= 1995; now probably more than 2 million). For a
specialist to keep up this means reading 25 articles every
day (for a GP more than 100!)
 Most of the new insights and treatment
methods don‟t reach the target group
Problem I: too much information

6. Postgraduate Course
Problem I: too much information
 HRM: 1,350 articles in 2010 (ABI/INFORM). For an HR
manager to keep up this means reading 3 to 4 articles
every day (for a „general‟ manager more than 50!)

7. Postgraduate Course
Problem II: persistent convictions
if you’re
hyperventilating
breathe into a bag

8. Postgraduate Course
Problem III: jumping to conclusions
elderly people who have
an irregular heartbeat are
much more likely to die of
coronary disease
give them a drug that
reduces the
number of
irregular beats

9. Postgraduate Course
How 40,000 cardiologists can be wrong
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.

10. Postgraduate Course
David Sackett
 Half of what you learn in medical school will be
shown to be either dead wrong or out-of-date
within 5 years of your graduation; the trouble is that
nobody can tell you which half.
 The most important thing to learn is how to learn
on your own.
 (Remember that your teachers are as full of bullshit
as your parents)

11. Postgraduate Course
Evidence-Based Practice
1991 Medicine
1998 Education
1999 Social care
2000 Nursing
2000 Criminal justice
???? Management?

12. Postgraduate Course

13. Postgraduate Course
Management: Founding Mother

14. Postgraduate Course
Jeffrey Pfeffer Robert Sutton
Management: Founding Fathers

15. Postgraduate Course
“Good managers use both individual managerial
expertise and the best available external evidence, and
neither alone is enough. Without managerial expertise,
practice risks becoming tyrannized by evidence, for even
excellent external evidence may be inapplicable to or
inappropriate for an individual organization or team.
Without current best evidence, practice risks becoming
rapidly out of date, to the detriment of organizations and
employees.”
Evidence based decision

16. Postgraduate Course
Individual Managerial Expertise
 Managerial skills and managerial judgment
 Vital for determining whether the evidence applies
to an individual organization (division, team) at all
and, if so, how
Evidence based decision

17. Postgraduate Course
5-step approach
EBMgt is a 5-step approach
1. Formulate an answerable question (PICOC)
2. Search for the best available evidence
3. Critical appraise the quality of the found evidence
4. Integrate the evidence with managerial expertise
and organizational concerns and apply
5. Monitor and evaluate the results