Presentation Evidence-Based Heathcare Logistics Erasmus University Oct 13, 2011 Eric Barends

1. Evidence-Based ManagementWhat is it?Why do we need it?How does it look like in practice? Congres Evidence-Based Zorglogistiek, 13 oktober 2011

2. Postgraduate Course Evidence based management: What is it?

3. Definition Evidence-based management means making decisions about the management of employees, teams or organizations through the conscientious, explicit and judicious use of four sources of information: 1. The best available scientific evidence 2. Organizational facts, metrics and characteristics 3. Stakeholders’ values and concerns 4. Practitioner expertise and judgment

4. Four sources

5. What is evidence? Postgraduate Course Evidence is not the same as ‘proof’ or ‘hard facts’ Evidence can be - so strong that no one doubts its correctness, or - so weak that it is hardly convincing at all

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

7. Management: Founding Mother Postgraduate Course

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

9. Postgraduate Course 2. Evidence-based management: Why do we need it?

11. Drawing on available evidence (including research produced by academics) is likely to improve decisions

12. Organizations do not appear to be strongly aware of nor use research findings

15. Mental corner cutting

16. Misinterpretation of incomplete data

17. Halo effect

18. False consensus effect

19. Reinterpreting evidence

20. Group think

21. Confirmation bias

22. Authority bias

23. In-group bias

24. Recall bias

25. Anchoring bias

26. Inaccurate covariation detection

28. Mental corner cutting

29. Misinterpretation of incomplete data

30. Halo effect

31. False consensus effect

32. Reinterpreting evidence

33. Group think

34. Confirmation bias

35. Authority bias

36. In-group bias

37. Recall bias

38. Anchoring bias

39. Inaccurate covariation detection

41. Seeing order in randomness Postgraduate Course We are patern seeking primates: association learning

50. Points of impact of V-1 bombs in London Postgraduate Course

51. Points of impact of V-1 bombs in London Postgraduate Course

53. A Type II error or a false negative, is not believing a pattern is real when it is (not recognizing a real pattern)Dr. Michael Shermer (Director of the Skeptics Society)

55. Errors and Biases of Human Judgment Postgraduate Course Jennifer Whitson, University of Texas Austin, corporate environments

56. Errors and Biases of Human Judgment Postgraduate Course Erroneous beliefs plaque both experienced professionals and less informed laypeople alike. stress peptic ulcer

57. Oct 2005 Peptic ulcer – an infectious disease! This year's Nobel Prize in Physiology or Medicine goes to Barry Marshall and Robin Warren, who with tenacity and a prepared mind challenged prevailing dogmas. By using technologies generally available (fibre endoscopy, silver staining of histological sections and culture techniques for microaerophilic bacteria), they made an irrefutable case that the bacterium Helicobacter pylori is causing disease. By culturing the bacteria they made them amenable to scientific study. In 1982, when this bacterium was discovered by Marshall and Warren, stress and lifestyle were considered the major causes of peptic ulcer disease. It is now firmly established that Helicobacter pylori causes more then 90% of duodenal ulcers. The link between Helicobacter pylori infection and peptic ulcer disease has been established through studies of human volunteers, antibiotic treatment studies and epidemiological studies.

58. Errors and Biases of Human Judgment Postgraduate Course Doctors, teachers, lawyers and managers hold many erroneous beliefs, not because they are ignorant or stupid, but because they seem to be the most sensible conclusion consistent with the available evidence. They hold such beliefs because they seem to be the irresistible products of their own professional experience. They are the products, not of irrationality, but of flawed rationality

60. Mental corner cutting

61. Misinterpretation of incomplete data

62. Halo effect

63. False consensus effect

64. Reinterpreting evidence

65. Group think

66. Confirmation bias

67. Authority bias

68. In-group bias

69. Recall bias

70. Anchoring bias

71. Inaccurate covariation detection

73. Business Process Reengineering

74. Management by results

75. Excellence

76. Total Quality Management

77. Learning Organizations

79. Management development

80. Executive coaching

81. Emotional intelligence

82. Employee engagement

83. Knowledge management

84. Myers Briggs Type Indicator

86. Group think: management fads Postgraduate Course The true value of conventional management wisdom is not that it's wise or dumb, but that it's conventional. It makes one of the hardest jobs in the world, managing an organization, a little easier. By following it, managers everywhere see a way to drag their sorry behinds through another quarter without getting fired. And isn't that, really, what it's all about?” (Colvin, 2004, Fortune)

87. Postgraduate Course So?

89. This requires that we think critically about experience, question our assumptions, and challenge what we think we know

91. Probleem2: kritischegeluiden Postgraduate Course “Managers maken Nederland ziek ... Steeds meer vakmensen (zoals docenten, verpleegkundigen, artsen) hebben het gevoel dat ze worden aangestuurd door managers die van het vak geen verstand hebben maar wel de dienst uitmaken.” Ad Verbrugge

92. Probleem2: kritischegeluiden Postgraduate Course “Of het nu gaatomeenziekenhuis of eendropfabriek, teveel managers hebben de pretentiedatzealleskunnenmanagenzonderook maar teletten op de inhoud van het werk. Het zijnfiguren die alseenvlo van de ene "uitdaging" naar de anderespringen, een spoor van verbittering en vernielingachterzichlatend.” Geert Mak

93. Probleem2: kritischegeluiden Postgraduate Course “Nog meer managers, nog meer reorganisaties, nog meer power point-presentaties, nog meer holle retoriek over topprestaties en topkwaliteit. De groeiende korst van nepfuncties die onze bedrijven, scholen en andere organisaties nutteloos belasten wordt almaar dikker .” Dorien Pessers

94. Brede maatschappelijke ontwikkeling Postgraduate Course

95. Brede maatschappelijke ontwikkeling Postgraduate Course “Waar de overheid, de dokter, de pedagoog en de manager vroeger een eenvoudig beroep op hun autoriteit konden doen, zullen zij nu met getallen en statistiek hun gelijk moeten aantonen.”

96. Brede maatschappelijke ontwikkeling Postgraduate Course Evidence basedmedicine Evidence basededucation Evidence basedcriminology Evidence basedsocialwelware Evidence based management?

97. Postgraduate Course Evidence based management: How does it look like in practice?

98. Four sources

99. JAMA, 1992

100. Push vs Pull Push: teaching (management) principles based upon a convergent body of research and telling students what to do. Pull: teaching (managers) how to find, appraise and apply the outcome of research (evidence) by themselves

101. The 5 steps of ‘pull’ EBP Formulate an answerable question Search for the best available evidence Critically appraise the evidence Integrate the evidence with your managerial expertise and organisational concerns and apply Monitor the outcome

102. The 5 steps of ‘pull’ EBP Formulate an answerable question Search for the best available evidence Critically appraise the evidence Integrate the evidence with your managerial expertise and organisational concerns and apply Monitor the outcome

103. Answerable question Postgraduate Course I am a consultant, my client a large health-care organization. The board of directors has plans for a merger with a smaller healthcare organization. However, it’s been said that the organizational culture differs widely between the two organizations. The board want’s to know if this can impede a successful outcome.

104. Answerable question: PICO(C) Postgraduate Course P= Population or problem I = Intervention or successfactor C= Comparison O= Outcome C = Context

105. Answerable question: PICOC Postgraduate Course 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?

106. The 5 steps of ‘pull’ EBP Formulate an answerable question Search for the best available evidence Critically appraise the evidence Integrate the evidence with your managerial expertise and organisational concerns and apply Monitor the outcome

107. Where do we search? Postgraduate Course

108. How do we search? Postgraduate Course

109. The 5 steps of ‘pull’ EBP Formulate an answerable question Search for the best available evidence Critically appraise the evidence Integrate the evidence with your managerial expertise and organisational concerns and apply Monitor the outcome

110. Critical appraisal Postgraduate Course How to read a research article?

111. Critical appraisal Postgraduate Course Study designs Levels of evidence Bias / confounding Effect sizes External validity

112. Research designs Which study for which question? The “best” evidence depends on the question type !

113. Levels of evidence

114. The 5 steps of ‘pull’ EBP Formulate an answerable question Search for the best available evidence Critically appraise the evidence Integrate the evidence with your managerial expertise and organisational concerns and apply Monitor the outcome

115. Organization concerns Always ask yourself to what extent the evidence is applicable in your situation: Is your organization / division / population so different from those in the study that its results cannot apply? How relevant is the study to what you are seeking to understand or decide? What are your organization’s potential benefits and harms from the intervention? Is the intervention feasible in your setting?

116. The 5 steps of ‘pull’ EBP Formulate an answerable question Search for the best available evidence Critically appraise the evidence Integrate the evidence with your managerial expertise and organisational concerns and apply Monitor the outcome

118. Voormeting?

121. Six Sigma?

122. Lean management?

123. Lean Six Sigma?

124. TOC/ Theory of Constraints?

125. Performance Management?