Congres Evidence-Based Zorglogistiek, 13 oktober 2011

Evidence-Based Management

What is it?Why do we need it?

How does it look like in practice?

1. Evidence based management:What is it?

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Postgraduate Course

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

Postgraduate Course

Four sources

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

What is evidence?Postgraduate Course

McMaster University Medical School, Canada

Medicine: Founding fathers

David Sackett Gordon Guyatt

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Management: Founding MotherPostgraduate Course

Jeffrey Pfeffer Robert Sutton

Management: Founding FathersPostgraduate Course

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

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EBMgt: some basic assumptionsPostgraduate Course

Research produced by management scholars could be useful to organizations

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

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

EBMgt is a potentially useful way of thinking about how we can incorporate research evidence into decision-making

Reason 1:Errors and Biases of Human

Judgment

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Seeing order in randomness

Mental corner cutting

Misinterpretation of incomplete data

Halo effect

False consensus effect

Reinterpreting evidence

Group think

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Errors and Biases of Human Judgment

Confirmation bias

Authority bias

In-group bias

Recall bias

Anchoring bias

Inaccurate covariation detection

Distortions due to plausibility

Seeing order in randomness Mental corner cutting

Misinterpretation of incomplete data

Halo effect

False consensus effect

Reinterpreting evidence

Group think

Postgraduate Course

Errors and Biases of Human Judgment

Confirmation bias

Authority bias

In-group bias

Recall bias

Anchoring bias

Inaccurate covariation detection

Distortions due to plausibility

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.

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Seeing order in randomness

We are patern seeking primates: association learning

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Seeing order in randomness

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Points of impact of V-1 bombs in London

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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)

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Errors and Biases of Human Judgment

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)

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Errors and Biases of Human Judgment

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)

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Errors and Biases of Human Judgment

Pattern detection problem

Assessing the difference between a Type I and Type II error is highly problematic (especially in split second ‘life and death’ situations), so the default position is to assume all patterns are real.

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Errors and Biases of Human Judgment

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Errors and Biases of Human Judgment

Jennifer Whitson, University of Texas Austin, corporate environments

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Errors and Biases of Human Judgment

Erroneous beliefs plaque both experienced professionals and less informed laypeople alike.

stress peptic ulcer

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.

Oct 2005

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Errors and Biases of Human Judgment

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

Seeing order in randomness

Mental corner cutting

Misinterpretation of incomplete data

Halo effect

False consensus effect

Reinterpreting evidence

Group think

Postgraduate Course

Errors and Biases of Human Judgment

Confirmation bias

Authority bias

In-group bias

Recall bias

Anchoring bias

Inaccurate covariation detection

Distortions due to plausibility

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Group think: management fads

The nearly-forgotten fads:

Scientific Management/Taylorism Business Process Reengineering Management by results Excellence Total Quality Management Learning Organizations Knowledge Management

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Group think: management fads

The fads that haven’t been forgotten (yet):

Talent management Management development Executive coaching Emotional intelligence Employee engagement Knowledge management Myers Briggs Type Indicator Belbin Team Roles

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Group think: management fads

“And there we see the power of any big managerial idea (or fad). It may be smart, like quality, or stupid, like conglomeration. Either way, if everybody's doing it, the pressure to do it too is immense. If it turns out to be smart, great. If it turns out to be stupid, well, you were in good company and most likely ended up no worse off than your competitors. Your company's board consists mostly of CEOs who were probably doing it at their companies. How mad can they get?

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Group think: management fads

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)

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So?

Managers seem to be extremely good at generating ideas, theories, and explanations that have the ring of plausibility. They may be relatively deficient, however, in evaluating and testing those ideas once they are formed.

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

(Show me the evidence!)

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Errors and Biases of Human Judgment

Reason 2:

De ‘buitenwereld’ wordt steeds kritischer

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Probleem 2: kritische geluiden

“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

Postgraduate Course

“Of het nu gaat om een ziekenhuis of een dropfabriek, te veel managers hebben de pretentie dat ze alles kunnen managen zonder ook maar te letten op de inhoud van het werk. Het zijn figuren die als een vlo van de ene "uitdaging" naar de andere springen, een spoor van verbittering en vernieling achter zich latend.”

Geert Mak

Probleem 2: kritische geluiden

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

Probleem 2: kritische geluiden

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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.”

Brede maatschappelijke ontwikkeling

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Evidence based medicine

Evidence based education

Evidence based criminology

Evidence based social welware

Evidence based management?

Brede maatschappelijke ontwikkeling

Evidence based management:How does it look like in practice?

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Postgraduate Course

Four sources

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JAMA, 1992

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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

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The 5 steps of ‘pull’ EBP

1. Formulate an answerable question

2. Search for the best available evidence

3. Critically appraise the evidence

4. Integrate the evidence with your managerial expertise and organisational concerns and apply

5. Monitor the outcome

Postgraduate Course

The 5 steps of ‘pull’ EBP

1. Formulate an answerable question2. Search for the best available evidence

3. Critically appraise the evidence

4. Integrate the evidence with your managerial expertise and organisational concerns and apply

5. Monitor the outcome

Answerable questionPostgraduate 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.

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P = Population or problem

I = Intervention or successfactor

C = Comparison

O = Outcome

C = Context

Answerable question: PICO(C)

Answerable question: PICOCPostgraduate 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?

Postgraduate Course

The 5 steps of ‘pull’ EBP

1. Formulate an answerable question

2. Search for the best available evidence3. Critically appraise the evidence

4. Integrate the evidence with your managerial expertise and organisational concerns and apply

5. Monitor the outcome

Where do we search?Postgraduate Course

How do we search?Postgraduate Course

Postgraduate Course

The 5 steps of ‘pull’ EBP

1. Formulate an answerable question

2. Search for the best available evidence

3. Critically appraise the evidence4. Integrate the evidence with your managerial

expertise and organisational concerns and apply

5. Monitor the outcome

Critical appraisal

How to read a research article?

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Critical appraisalPostgraduate Course

1. Study designs

2. Levels of evidence

3. Bias / confounding

4. Effect sizes

5. External validity

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Which study for which question?

Research designs

The “best” evidence depends on the question type !

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Levels of evidence

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The 5 steps of ‘pull’ EBP

1. Formulate an answerable question

2. Search for the best available evidence

3. Critically appraise the evidence

4. Integrate the evidence with your managerial expertise and organisational concerns and apply

5. Monitor the outcome

Postgraduate Course

1. Is your organization / division / population so different from those in the study that its results cannot apply?

2. How relevant is the study to what you are seeking to understand or decide?

3. What are your organization’s potential benefits and harms from the intervention?

4. Is the intervention feasible in your setting?

Organization concerns

Always ask yourself to what extent the evidence is applicable in your situation:

Postgraduate Course

The 5 steps of ‘pull’ EBP

1. Formulate an answerable question

2. Search for the best available evidence

3. Critically appraise the evidence

4. Integrate the evidence with your managerial expertise and organisational concerns and apply

5. Monitor the outcome

Postgraduate Course

Monitor the outcome

Uitkomst gemeten?

Voormeting?

Controlegroep?

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Do a trial!

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Monitor the outcome

Business Process Redesign?

Six Sigma?

Lean management?

Lean Six Sigma?

TOC/ Theory of Constraints?

Performance Management?

Of …..

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Vragen?