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Postgraduate Course
Evidence based management:
Where does it come from?
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?
Postgraduate Course
McMaster University Medical School, Canada
Medicine: Founding fathers
David Sackett Gordon Guyatt
Postgraduate Course
How it all started
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
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!)
Postgraduate Course
Problem II: persistent convictions
if you’re
hyperventilating
breathe into a bag
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
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.
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shown to be either dead wrong or out-of-date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)
Postgraduate Course
Evidence-Based Practice
1991 Medicine
1998 Education
1999 Social care
2000 Nursing
2000 Criminal justice
???? Management?
Postgraduate Course
Postgraduate Course
Management: Founding Mother
Postgraduate Course
Jeffrey Pfeffer Robert Sutton
Management: Founding Fathers
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
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
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

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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
  • 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?
  • 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