Arndt Margarete, Bigelow Barbara
Clark University, Graduate School of Management, Worcester, Massachusetts, USA.
Health Care Manage Rev. 2009 Jul-Sep;34(3):206-13. doi: 10.1097/HMR.0b013e3181a94288.
Health care managers are urged to adopt evidence-based management as a new and exemplary decision-making process. Three assumptions underlie advocacy for the practice: (a) Decisions based on evidence will yield anticipated results, (b) these results are generalizable across organizations, and (c) evidence is objective and context free.
This article explores evidence-based management through contextual and conceptual lenses that question these underlying assumptions.
A review of extant literature on evidence-based management was conducted.
Calls for evidence-based management are based mostly on conceptual arguments that it constitutes best practice because there is not yet any empirical research that demonstrates its effectiveness. We raise a cautionary note about the assumptions underlying the calls for evidence-based management. Given the complexity of decision making and of the health care environment, as well as differences among health care organizations, decisions do not necessarily lead to expected outcomes, and results may not be replicable across organizations. Moreover, evidence is an artifact of social interactions and limited by the difficulties inherent in studying complex organizational phenomena.
Research is needed into the diffusion of evidence-based management in health care and into the results achieved by organizations that used the practice compared with organizations that did not.
Managers should use all available information and data when planning and implementing decisions, and evidence from research should play a role in that. At the same time, in a turbulent and uncertain environment, creativity and risk taking also will be important, and unanticipated outcomes may result from, among other factors, limits on human cognition, unknowable differences in initial conditions in organizations, and adaptive responses to change as it is implemented.
医疗保健管理者被敦促采用循证管理作为一种全新且堪称典范的决策过程。对这种做法的倡导基于三个假设：（a）基于证据的决策将产生预期结果；（b）这些结果可在各组织间推广；（c）证据是客观且不受背景影响的。
本文通过质疑这些基本假设的背景和概念视角来探讨循证管理。
对现有的循证管理文献进行了综述。
对循证管理的呼吁大多基于概念性论点，即它构成最佳实践，因为尚无任何实证研究证明其有效性。我们对循证管理呼吁背后的假设提出警示。鉴于决策和医疗保健环境的复杂性，以及医疗保健组织之间的差异，决策不一定会带来预期结果，而且结果可能无法在各组织间复制。此外，证据是社会互动的产物，并受研究复杂组织现象所固有的困难限制。
需要对循证管理在医疗保健中的传播以及采用该做法的组织与未采用该做法的组织所取得的成果进行研究。
管理者在规划和实施决策时应利用所有可用信息和数据，来自研究的证据应在其中发挥作用。同时，在动荡和不确定的环境中，创造力和冒险精神也很重要，除其他因素外，人类认知的局限性、组织初始条件中不可知的差异以及对变革实施的适应性反应等可能导致意外结果。
