Evidence-based management in health care organizations: a cautionary note.

BACKGROUND

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.

PURPOSE

This article explores evidence-based management through contextual and conceptual lenses that question these underlying assumptions.

METHODS

A review of extant literature on evidence-based management was conducted.

FINDINGS

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.

CONCLUSION

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.

PRACTICE IMPLICATIONS

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.