1. Evidence-Based Management Looking Back and Forward Thomas Rundall, PhD University of California, Berkeley

2. Topics for Today’s Presentation Looking Back: The Emerging Field of EBMgt – The Origins of the Modern Era – Some Features of the Fields From Which EBMgt Is Emerging Practice Research Teaching Looking Forward: Encouraging Developments Increasing Institutionalization of EBMgt Four Recommendations 2

3. What is Evidence-Based Management? Evidence-based management means making decisions about the management of employees, teams or organizations through conscientious, explicit and judicious use of four sources of information 1.The best available scientific evidence 2.The best available organizational evidence 3.The best available experiential evidence 4.Organizational values and stakeholder’s concerns 3

4. Best Available Scientific Evidence Organizational Facts and Characteristics Managerial Expertise and Judgement Stakeholders’ Values and Concerns Evidence-based Decision Source: Center for Evidence-Based Management 4

5. Looking Back The Emerging Field of EBMgt 5

6. The Origins of the Modern Era Towards an Evidence Based Health Care Management Runo Axelsson International Journal of Health Planning and Management, 1998 6

7. Management theory and research is not useful to managers “During the past 10 years organizational theory has become more and more esoteric and largely dissociated from the problems of management. At the same time, organizational research seems to have come to a scientific dead end, where nothing can be proved or disproved any longer. Knowledge about organizations has reduced to a question of culture, language and symbols … 7

8. The research efforts have been limited to understanding different aspects of organizational life, rather than trying to explain and predict the consequences of managerial action … With this orientation, the results from organizational research have become less and less relevant for practical management … 8

9. It is difficult to escape the feeling of resignation in this research on organizations. The research seems to have become an end in itself and has very little relevance for practical management. Instead the field has been left wide open for consultants and different charlatans to influence managers with their fashionable models of organization and management.” Runo Axelsson, 1998 9

10. Yes, it’s quite a noise – but are we having any impact? 10

11. Some Features of the Fields from Which EBMgt Is Emerging Emerging from the field of management practice – in which there is no universally accepted certification to enter the profession – there has been little collaboration with researchers – in which research has been sparingly used; there is a gap between what we know and what we do in many management areas 11

12. Some Features of the Fields from Which EBMgt Is Emerging Emerging from the field of management research – that lacks broad agreement on fundamental issues such as whether the field should be advancing prescriptive advice to improve organizational performance or non- prescriptive understandings of life within organizations – that lacks structures, processes and incentives to produce and disseminate actionable management findings 12

13. Some Features of the Fields from Which EBMgt Is Emerging Emerging from a field of management teaching in which there is little emphasis on the steps required to practice EBMgt or the skills necessary to apply research evidence to managerial decisions 13

14. Looking Forward: Encouraging Developments in Health Care Management Practice Research Teaching Institutional Development 14

15. Management Practice in Health Care Organizations Increasing interest and receptivity to EBMgt, stimulated by – the patient safety and quality of care movement – widespread demands for reducing the cost of care: risk-based contracts, value-based purchasing, etc. – both forces exemplified by the emergence of Accountable Care Organizations 15

16. Management Research in Health Services Greater emphasis by funding agencies and research community on implementation, evaluation and translational research Journals extending their reach to practitioners – Plain language summaries of research findings – Practitioner responses to articles Increasing case studies of EBMgt in practice 16

17. Management Teaching Suggestions for how to incorporate EBMgt in curricula are available – Rousseau, D.M. & McCarthy S., Educating Managers From an Evidence-Based Perspective, Academy of Management Learning and Education, 2007 – Rundall, T., Refocusing Future Faculty on Evidence-based Health Services Management Research, Journal of Health Administration Education, 2004 Courses are being added to management curricula – 25% of core MBA courses use EBMgt in some form (Charlier and Brown, Academy of Management, 2011) 17

18. Management Teaching “Model” course syllabi available on-line: e.g. Denise Rousseau’s course Evidence Based Management, http://www.heinz.cmu.edu/Courses/397syl.pdf http://www.heinz.cmu.edu/Courses/397syl.pdf The Informed Decisions Toolbox is available to support course projects: http://www.ahrq.gov/policymakers/measurement/decisionto olbx/index.html http://www.ahrq.gov/policymakers/measurement/decisionto olbx/index.html 18

19. Institutional Development of EBMgt Growing literature developing the concepts, practices and examples of use of EBMgt – Rousseau (Ed.), The Oxford Handbook of Evidence-Based Management. Oxford University Press, 2012 – Kovner, Fine & D’Aquila (Eds.) Evidence-based Management in Healthcare, 2009 Increasing consensus on definition, key concepts, steps, techniques, etc. 19

20. Institutional Development of EBMgt Communities of practice, e.g. the Evidence-Based Management Collaborative at Carnegie Mellon University: http://wpweb2.tepper.cmu.edu/rlang/ebm_conf/index.html http://wpweb2.tepper.cmu.edu/rlang/ebm_conf/index.html Centers dedicated to promoting evidence-based practice, e.g. the Center for Evidence-Based Management in Amsterdam: http://www.cebma.orghttp://www.cebma.org Web-based Blogs and other related sites, e.g. Evidence-based Managament (Pfeffer & Sutton), Stanford University: http://blog.stanford.edu/node/145 http://blog.stanford.edu/node/145 20

21. Four Recommendations to Further Institutionalize EBMgt 1.Curriculum Development: embed EBMgt in a.Introduction to Health Services Management (and Policy) b.Specialty courses such as strategic planning, human resource management, financial management, and quality and patient safety (Faculty Forum recommendations?) c.Capstone projects 2.Expand EBMgt communities of practice 21

22. Four Recommendations to Further Institutionalize EBMgt 3.Create and disseminate a comprehensive vision of an evidence-based approach to management in health care organizations a.Strategic Dimension: external demands for performance accountability b.Structural Dimension: accountability structure for knowledge transfer c.Cultural Dimension: questioning organizational culture d.Technical Dimension: participation in management research 4.Create a National Evidence-based HealthCare Management Center, including a repository of management research similar to the Cochran Collaboration 22

23. Thank You! 23