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Victor Rodwin | How does the healthcare in NYC compare to other world cities?Health.
Anthony Kovner | What greater role can Evidence-Based Management play in healthcare?Health.
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Evidence-Based Management is the Road Less Traveled, Says Prof. Anthony Kovner
When organizations or businesses stumble, the search for an explanation often leads back to the quality of the evidence-gathering process. It is that process, known as Evidence-based Management (EBM), that fascinates Anthony R. Kovner, who has spent more than a decade trying to get managers to employ it when they seek ways to improve their organization’s performance and results.
Professor Kovner teaches EBM to students at the Robert F. Wagner Graduate School of Public Service, where he is a professor of public and health management and the director of the Executive MPA Program for Nurse Leaders. He is also the author of several books on healthcare management. Shortly before the publication of a chapter he recently wrote, entitled “Adventures in the Evidence-based Management Trade,” for the forthcoming Oxford Handbook of Evidence-Based Management (Oxford University Press), he sat down with NYU Research Digest (Spring 2012) to discuss Evidence-based Management.
What’s the theory behind EBM?
Evidence-based Management comes out of medicine—the idea that if you make a medical intervention, it should have a predictable and positive outcome. We said, “Why can’t we apply this in management?” Well, the truth is, it’s not a simple matter. We know a lot less about management than medicine, for which there’s a huge medical research establishment, the randomized clinical trial, and an established process for scientific review.
What professional sector does EBM most lend itself to?
To every sector. So for example, when two large health organizations decide to merge, we say, “Wouldn’t it make sense to look at the best available evidence before making a decision to merge?” Instead, a very common managerial response is: “We want to merge—let’s find the evidence that justifies it.” So these managers need to do more than just type “hospital merger” in Google? Keep in mind that all managers make decisions based on evidence. The point is, what is the quality of the evidence? It can be pretty shabby.
What’s wrong with the process as it works now?
When, for instance, two large institutions decide to merge, to what extent do they ask in advance, “What do we know about successful and unsuccessful mergers?” Generally speaking, what they do is ask the consultants, and the consultants say, “This would work in Akron.” But of course that doesn’t mean that it would work in Brooklyn. Are the merging institutions’ two geographies compatible? What about their respective cultures? It’s not that you get to a solution—these kinds of problems are too messy, too wicked, and the causation is not as clear as in randomized clinical trials. But it informs your thinking so you can see and avoid the worst consequences of what might happen.
How should the evidence gathering begin?
Three basic steps: search and locate the best available evidence, learn from best practices, and try doing your own management research. If you are studying why nurses turn over so much in your hospital, it’s important for you to understand the differences between the 12-hour day shift and the 12-hour night shift. The most important step, though, is to ask the right question, and translate your management challenge into an answerable one.
If EBM is so effective, why don’t more organizations engage in it?
That’s the $64,000 question, and it’s not an easy question to deal with. What it really is about is power and hierarchy and organizations. Let’s say an employee comes up with a better way of doing something and tells the boss about it. You’d expect the boss to say it’s a great idea, let’s do it. But in practice the boss says, “You’re insulting the way I’m managing this place,” or “If you thought of it, then how good can it be, if I didn’t think of it,” or “Go ahead and present your ideas to the higher-ups, and if they like it I’ll take credit for it, and, if they don’t we’ll blame you. “
That sounds almost insurmountable.
The trick of it is to make the politics work for you. To get it implemented, you have to get the managers to see that it’s in their political interest to practice evidence-based management. And I believe it is.”
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