Evidence-Based Decision Making for Hospital Administrators

Evidence-Based Decision Making
If doctors can do it... administrators can do it?
NVZD Voorjaarscongres – 4 Juni 2015 - Nyenrode

Exercise
Think about a decision you have been involved in
making. This decision should be one which:
Was reasonably important for your organization
Involved spending significant resources
Involved several or more people
Was made over a period of time (ie. weeks or months)
Did not have an easy ‘answer’

Exercise
Discuss with your neighbor (1 min)
What exactly was the problem (or opportunity)?
How many alternative decision options were considered?
How much evidence was used, and from which sources
(scientific, organizational, experience, crystal ball?)
Was any attempt made to explicitly evaluate its quality or
trustworthiness?

Evidence based decision-making:
What is it?

Evidence-based decision making
Central Premise:
Decisions should be based on a
combination of critical thinking and
the ‘best available evidence‘.

Evidence?
outcome of scientific research,
organizational facts & figures,
benchmarking, best practices,
personal experience

All managers and leaders
base their decisions on
‘evidence’

But…many managers and
leaders pay little or no
attention to the quality of the
evidence they base their
decisions on

Trust me, 20 years of
management experience

Teach managers/leaders
how to critically evaluate the
validity, and generalizability of
the evidence and help them
find ‘the best available’
evidence

Evidence based decision
Professional
experience and
judgment
Organizational data,
facts and figures
Stakeholders’ values
and concerns
Scientific
research
outcomes
Ask
Acquire
Appraise
Aggregate
Apply
Assess
diagnosis intervention

Evidence based practice:
Where does it come from?

McMaster University Medical School, Canada
Medicine: Founding fathers
David Sackett Gordon Guyatt

1. Ask: translate a practical issue into an answerable question
2. Acquire: systematically search for and retrieve the evidence
3. Appraise: critically judge the trustworthiness of the evidence
4. Apply: incorporate the evidence into the decision-making process
5. Assess: evaluate the outcome of the decision taken
5 steps of EBmed

Evidence-Based Practice
1991 Medicine
1998 Education
2000 Social care, public policy
Nursing, Criminal justice,
Policing, Architecture, Conservation
2010 Management

Evidence-based decision-making
=
the use of evidence from multiple
sources to increase the likelihood of a
favourable outcome
Focus on the decision making process
Think in terms of probability

Evidence-Based Decision-Making
Why do we need it?

1. Incompetent people benefit more from feedback than
highly competent people.
2. Task conflict improves work group performance while
relational conflict harms it.
3. Encouraging employees to participate in decision
making is more effective for improving organizational
performance than setting performance goals.
True or false?

How evidence-based is your HR director?
 959 (US) + 626 (Dutch) HR professionals
 35 statements, based on an extensive body of evidence
 true / false / uncertain
HR Professionals' beliefs about effective human resource practices: correspondence
between research and practice, (Rynes et al, 2002, Sanders et al 2008)

Outcome: not better than random chance

Professional
experience and
judgment
facts and figures
and concerns
Scientific
research
outcomes
Ask
Acquire
Appraise
Aggregate
Apply
Assess

Thinking critical about
professional experience and judgment

Discuss with your neighbor (1 min)
Why is a physician’s clinical experience,
as a rule, more trustworthy than
a manager’s professional experience?

Developing expertise
1. A sufficiently regular, predictable environment
2. Opportunities to learn regularities through prolonged
practice and feedback
The management domain is not highly
favorable to expertise!

Bounded rationality / prospect theory
System 1
 Fast
 Intuitive, associative
 heuristics & biases
System 2
 Slow (lazy)
 Deliberate,
 Reasoning
 Rational

Shepard’s tables
System 1: short cuts

System 1: necessary to survive
95%

 Seeing order in randomness
 Overconfidence bias
 Halo effect
 False consensus effect
 Group think
 Self serving attribution bias
 Sunk cost fallacy
 Cognitive dissonance reduction
System 1: cognitive errors
 Confirmation bias
 Authority bias
 Small numbers fallacy
 In-group bias
 Recall bias
 Anchoring bias
 Availability bias

1. Pattern recognition
2. Confirmation-bias
3. Groupthink
Cognitive errors

We are predisposed to see order, pattern and causal
relations in the world.
Patternicity: The tendency to find meaningful patterns in
both meaningful and meaningless noise.
Error 1: pattern recognition

We are pattern seeking primates: association learning
Bias 1: pattern recognition

Points of impact of V-1 bombs in London

 A Type I error or a false positive, is
believing a pattern is real when it is not
(finding a non existent pattern)
 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)

 A Type I error or a false positive: believe that the
rustle in the grass is a dangerous predator when it is
just the wind (low cost)

 A Type II error or a false negative: believe that the
rustle in the grass is just the wind when it is a
dangerous predator (high cost)

 A Type I error or a false positive: believe that the
rustle in the grass is a dangerous predator when it is
just the wind (low cost)
 A Type II error or a false negative: believe that the
rustle in the grass is just the wind when it is a
dangerous predator (high cost)

superstitious
rituals
superstitious
rituals
more stress = more prone to type 1 errors

We are predisposed to selectively
search for or interpret information in
ways that confirms our existing beliefs,
expectations and assumptions, and
ignore information to the contrary.
In other words, we “see what we want to
see”
2. Confirmation bias

Example
You may believe that astrology actually
works. As a result of confirmation bias
you’ll remember only those instances
when when the prediction in the astrology
column came true and forget the majority
of the cases when the prediction was very
wrong. As a result you will continue to
believe astrology has some base in reality
2. Confirmation bias

Confirmation bias
Pattern recognition
Error 2: confirmation bias

McKinsey (1997 case study / 2001 book)

1. Pattern recognition
2. Confirmation-bias
3. Groupthink
Errors

Groupthink:
Groupthink is a psychological
phenomenon that occurs within a
group of people, in which the desire
for harmony or conformity in the
group results in an incorrect or
irrational decision
Error 3: Groupthink

Lean Management / Lean Six Sigma
Self steering / autonomous teams
Agile working / New World of Working
Value based management / health care
Talent management
Employee engagement
Group think?

“I’ve been studying judgment for 45 years, and I’m no better
than when I started. I make extreme predictions. I’m over-
confident. I fall for every one of the biases.”
Bounded rationality

Professional
experience and
judgment
and concerns
Scientific
research
outcomes
Ask
Acquire
Appraise
Aggregate
Apply
Assess
facts and figures

People operate with beliefs
& biases. To the extent you
can reduce both and replace
them with data, you gain a
clear competitive advantage
Laszlo Bock (CHRO Google)
Organizational data

1. financial data (cash flow, solvability)
2. business outcomes (ROI, market share)
3. customer/client impact (customer satisfaction)
4. performance indicators (occupancy rate, failure
frequency)
5. HR metrics (absenteeism, employee engagement)
6. marketing intelligence (brand awareness, customer
feedback)
7. ‘soft’ data (organizational culture, trust in senior
management, leadership style, commitment)
8. data from benchmarking
Types organizational evidence

Organizational facts and figures

Can your organization correlate/regress
level of education
years of experience
productivity
customer satisfaction
failure frequency
employee satisfaction
employee turnover
absenteeism
+

“Where the evidence is strong, we should act on it.
Where the evidence is suggestive, we should consider it.
Where the evidence is weak, we should build the
knowledge to support better decisions in the future.”
Jeffrey Zients, acting director of the
Office of Management and Budget and
President Obama’s Economic Advisor

In the next weeks,
before you make a decision, ask yourself:
 What exactly is the problem?
 What is the evidence available?
 Was any attempt made to explicitly
evaluate its trustworthiness?

Evidence-Based Decision Making for Hospital Administrators

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