Use of evidence-based management in healthcare administration decision-making

Challenges of using evidence in managerial decision-making of the primary health care system

BACKGROUND

Managerial Evidence-Based Decision-Making [EBDM] in the primary is a systematic approach that directs the decision-maker in a conscientious, explicit, and judicious utilization of reliable and best evidence based on the professional experiences and preferences of stakeholders and patients from various sources. This study aimed to investigate the challenges primary healthcare managers encounter while undertaking decision-making processes.

METHOD

A systematic review was conducted in 2022 with the aim of identifying and collecting all qualitative articles pertaining to evidence-based decision-making in the primary healthcare system. To achieve this, a meticulous search was conducted using the relevant keywords, including primary health care and evidence-based decision making, as well as their corresponding synonyms, across the databases Web of Science, Scopus, and Pubmed. Importantly, there were no limitations imposed on the timeframe for the search. To carefully analyze and consolidate the findings of this systematic review, the meta-synthesis approach was employed.

RESULTS

A total of 22 articles were assessed in this systematic review study. The results revealed the main categories including evidence nature, EBDM barriers, utilizing evidence, decision-makers ability, organizational structure, evidence-based, EBDM support, communication for EBDM, evidence sides, EBDM skill development, public health promotion, and health system performance improvement.

CONCLUSION

The primary healthcare system is crucial in improving health outcomes and ensuring access to healthcare services for all individuals. This study explored the utilization of evidence-based EBDM within the primary healthcare system. We identified five key dimensions: causal, contextual, and intervening conditions, strategies, and consequences of EBDM as a core phenomenon. The findings will help policymakers and administrators comprehend the importance of evidence-based decision-making, ultimately leading to enhanced decision quality, community well-being, and efficiency within the healthcare system. EBDM entails considering the best reliable evidence, and incorporating community preferences while also exploiting the professional expertise and experiences of decision-makers. This systematic review has the potential to provide guidance for future reforms and enhance the quality of decision-making at the managerial level in primary healthcare.

Measured and perceived impacts of evidence-based leadership in nursing: a mixed-methods systematic review protocol

INTRODUCTION

Despite the abundance of existing literature on evidence-based nursing practice, knowledge regarding evidence-based leadership, that is, leadership supported by an evidence-based approach, is lacking. Our aim is to conduct a mixed-methods systematic review with qualitative and quantitative studies to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurses and nurse leaders and their performance as well as on organisational and clinical outcomes.

METHODS AND ANALYSIS

We will search the following databases with no year limit or language restrictions: CINAHL (EBSCO), Cochrane Library, Embase (Elsevier), PsycINFO (EBSCO), PubMed (MEDLINE), Scopus (Elsevier) and Web of Science. In addition, the databases for prospectively registered trials and other systematic reviews will be screened. We will include articles using any type of research design as long as the study includes a component of an evidence-based leadership approach. Three reviewers will independently screen all titles, abstracts and full-text articles and two reviewers will extract the data according to the appropriate checklists. The quality of each study will be appraised using specific appraisal tool fitting in study design used in each study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) grid, PRISMA Protocols, Synthesis Without Meta-analysis and ENTREQ will guide the study process and reporting. Outcomes related to individual or group performance of nurses or nurse managers regarding leadership skills (e.g., communication skills), organisational outcomes (e.g., work environment, costs) and clinical outcomes (e.g., patient quality of life, treatment satisfaction) will be extracted and synthesised.

ETHICS AND DISSEMINATION

This systematic review will not include empirical data, and therefore, ethics approval will not be sought. The results of the review will be disseminated in a peer-reviewed scientific journal and in a conference presentation.

PROSPERO REGISTRATION NUMBER

CRD42021259624.

Malocclusion in individuals with osteogenesis imperfecta: A systematic review and meta-analysis

OBJECTIVE

To evaluate whether individuals with osteogenesis imperfecta (OI) are more affected by malocclusion than individuals without OI.

MATERIALS AND METHODS

Searches in PubMed, Ovid, Web of Science, Scopus, Lilacs and gray literature were performed. Data extraction was conducted by two researchers. Risk of bias assessment employing the Newcastle-Ottawa Scale and meta-analysis were conducted. Results were provided with mean difference (MD), odds ratio (OR) and 95% confidence interval (CI). Strength of evidence was determined.

RESULTS

Six cross-sectional studies were included. In comparison with individuals without OI, the group with OI had 19.69-fold greater chance of exhibiting Angle Class III malocclusion (OR = 19.69, CI: 9.00-43.09) and presenting anterior crossbite greater (MD = 6.08, CI: 2.40-9.77). Individuals without OI had a significantly greater ANB angle (MD = 3.88, CI: 1.15-6.61) and SNA angle (MD = 2.11, CI: 0.24-3.98) in comparison with those with OI. No difference between groups was found for SNB (MD = -0.50, CI: -2.21 to 1.21) and open bite (MD = 0.98, CI: -0.29 to 2.25). Most studies included had moderate methodological quality. Strength of evidence was low or very low.

CONCLUSIONS

The occurrence of Angle Class III malocclusion and anterior crossbite was greater among individuals with OI compared to those without OI. These findings can assist stakeholders about the occlusal abnormalities affecting OI individuals.

Knowledge management in health care: an integrative and result-driven clinical staff management model

Purpose

This paper aims to propose an integrative and result-driven health-care knowledge management (HKM) model and discuss the findings of a research that examines how the KM initiatives of a major private Brazilian hospital system are linked to its health-care performance outcomes.

Design/methodology/approach

Data were collected from a top-level Brazilian private hospital system (Mater Dei Healthcare System – MDHS), which is composed of three large hospitals internationally accredited by ISO 9001/2000, NIAHO and JCI. Multiple qualitative approaches were used to collect data such as 16 in-depth interviews with health professionals and managers, document analysis, participatory observation and benchmarking interviews with two reference hospital networks in Brazil.

Findings

The proposed health-oriented KM model is an expansion of the organizational knowing cycle model (Choo, 1996), adding absorptive capacity (ACAP) as a new construct. The paper discusses how ACAP integrates with sense-making, knowledge creation and decision-making processes within the health-care context. Information technology and clinical governance were identified as support factors to the HKM processes.

Practical implications

The paper presents a pragmatic and result-driven knowledge management (KM) model using health-care-welfare key performance indicators, as well as the emergence of KM as an integrative and strategic approach to hospital management.

Originality/value

The present study presents a knowledge-based perspective to clinical staff management, demonstrating the tangible results of KM initiatives that contribute to health and management performance outcomes.

Barriers, Facilitators, Process and Sources of Evidence for Evidence-Based Management among Health Care Managers: A Qualitative Systematic Review

Background

Evidence-based management (EBMgt) improves managerial decisions as a bridge from theory to practice. For reason that it has a critical impact on organization performance. The purpose of this study was to identify factors affecting EBMgt among managers.

Methods

The following electronic databases were used: PubMed, Web of Science, Cochrane, ProQuest, Embase and Scopus. In addition, we searched Google Scholar, Emerald, Academy of Management (AOM), and the website for the Center for Evidence-Based Management (CEBMa) for articles related to EBMgt. We used data sources published up to September 2017, without language restriction. We appraised the methodological quality of studies using the checklists of SRQR and MMAT. The synthesis involved interpretative analysis based on the principles of meta-synthesis.

Results

Of 26,011 identified studies, 26 met the full inclusion criteria. Of the 26 studies assessed, the frequency of qualitative studies and mixed-methods were 20 and 6, respectively, and the quality of 3 studies was weak. A total of 23 studies from 7 countries were included: Canada (n=8), USA (n=6), Australia (n=4), UK (n=3), Iran (n=1, Brazil (n=1); none were from Africa. Meta-synthesis findings of 23 studies identified four main factors: facilitators (5 main themes), barriers (5 main themes), sources of evidence (4 main themes), and the process of decision making in EBMgt (1 main theme).

Conclusions

EBMgt is crucial to improve the quality of management decisions, and hence, to improve service delivery, effectiveness and efficiency. Furthermore, to increase the benefit and utilization of EBMgt, training organizations and research institutes must more actively involve managers in setting research plans.

An Evidence-Based Framework for Evidence-Based Management in Healthcare Organizations: A Delphi Study

Background

Evidence-based management (EBMgt) is a growing literature concept in management sciences which claims that management decision-making must be based on the best available evidence. The aim of this paper is to present and provide an evidence-based framework for EBMgt to improve decision-making in healthcare organizations.

Methods

A two-round Delphi survey was used to collect the factors affecting EBMgt. Purposive and snowball sampling methods were used in both rounds. In round 1, we conducted a systematic review and a series of semi-structured interviews (n=45). In round 2, a specific questionnaire with four main parts was designed. The experts (n=21) were asked to rate on a 9-point Likert scale the importance of each factor. The data was collected through Google Forms (n=11) and paper forms (n=10).

Results

Participants were mostly men (73%). Overall, 126 factors were selected in round 1. Factors were classified into 4 categories: facilitators, barriers, the sources of evidence and EBMgt process that consisted of 48, 46, 22 and 10 factors, respectively. In round 2, based on median scores, many factors (n=114) were found to be very important. Only, 12 factors have a median score of less than 3 and were excluded from the study. Finally, 114 factors were confirmed.

Conclusions

Confirmed factors played significant roles in affecting the practice of EBMgt among healthcare managers. We tried to facilitate interaction between these factors in the framework. Depending on the type of problem, using six steps of EBMgt process, managers will select the best evidence among six sources of evidence.

Learning to lead: a review and synthesis of literature examining health care managers' use of knowledge

Background

Scholarship cites health care managers (HCMs) as not using research evidence in their management practice. The purpose of this review was to evaluate the effectiveness of interventions to enhance HCMs use of research evidence in practice.

Methods

We carried out a systematic review and focus groups to validate the review findings. We searched 10 electronic databases for studies reporting on interventions for HCMs to enhance research utilization in their practice. Qualitative studies were analysed using Hoon’s approach to meta-synthesis.

Results

Seven, primarily qualitative, studies of varying quality (reported in 11 articles) met our inclusion criteria. Interventions to enhance research use by HCMs included: informal and formal training, computer-based application, executive-level knowledge translation activities and residency programmes. Studies did not report efficacy of interventions or impacts of increasing managers’ use of research on staff or patient outcomes. Meta-synthesis yielded four contextual factors influencing the perceived effectiveness of interventions to enhance research use by HCMs: organizational culture, competing priorities, time as a resource and capacity building. Included studies differed in how they defined research and demonstrated varying understandings of research among HCMs, limiting the generalizability of work in this field.

Conclusions

Healthcare managers are increasingly called upon to make evidence-based decisions in practice, but the small number of studies and diverse strategies employed hinder our ability to identify any intervention to increase use of evidence as superior. Future studies in this area should clearly articulate the definition of research evidence they base their decisions on. Registration: PROSPERO (CRD42014006256)