Professional Documents
Culture Documents
EBMgt Clean
EBMgt Clean
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Introduction
Background
Healthcare management is “the profession that provides leadership and direction to organizations
that deliver personal health services and to division, departments, units, or services within those
organizations”.6 In accordance, healthcare managers are professionals who lead and direct health
organizations at different levels. Healthcare managers are leaders with the authority to make
decisions. Such decisions have a significant impact on the efficiency of the healthcare delivery
process and the success of healthcare organizations. Ensuring the quality and safety of the
delivered healthcare, cost efficiency and effectiveness requires the hospital manager to practice
through the conscientious, explicit, and judicious use of four sources of information:
administrator expertise and judgment, evidence from the local context, a critical assessment of
the best available research evidence, and the perspectives of that population who might be
affected by the organizational decisions (5). The basic concept of EBM is that high-quality
decisions need both critical thinking and the use of the ‘best available evidence’. This ‘evidence’
may come from scientific research, but internal hospital information and even professional
considered one of the necessary competencies for the effective management of modern
healthcare organizations and has proposed management competencies that include acquiring,
appraising and implementing scientific research findings for management decisions.9 Therefore,
hospital managers are forced to practice EBM in order to attain the effective management
(2,8,12–18).
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Statement of the Problem
Healthcare settings are complex; consequently, the types of decisions that must be made are
usually complicated too. Often, decisions are based on incomplete and outdated information and
personal experiences [4]. Therefore, using evidence in the decision-making process can lead to
improving the quality of managerial decisions [5]. Managers should make effective and efficient
decisions that lead to better productivity of the organization [1], and the accurate and precise use
of best evidence from different sources for increasing the outcomes is the result of EBM [6].
quality patient care and the success of healthcare organizations. Therefore, it is important for
healthcare managers to gain EBM knowledge and skills and adopt EBM as the best practices in
decision-making to improve quality patient care and health service access, and to reduce health
cost.
Despite the growing emphasis on EBM to attain effective management, many public health
EBM has been slowly adopted by healthcare managers. 12 To enhance the uptake of EBM, it is
necessary to determine the current status of EBM practice and identify factors affecting the
practice of EBM. However, there is limited knowledge regarding the extent of adoption and
factors influencing the practice of EBM among managers of the Ethiopian public health
institutions. This study seeks to fill this gap by examining the status of EBM practices and
associated factors among managers of public health institutions in Addis Ababa. This information
ultimately improving the quality of healthcare services provided by public health institutions.
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Justification and Significance of the Study
There are several justifications and significance of conducting research on EBM practices and
associated factors among managers of public health institutions. Firstly, EBM practices have
been proven to contribute to the effectiveness and efficiency of public health institutions. These
practices are based on rigorous scientific research and use objective data as a basis for decision
making. Therefore, it's important to understand the factors that facilitate or hinder the adoption of
Secondly, research on EBM practices can provide insights into the challenges faced by managers
in implementing these practices in public health institutions. This information can be used to
develop strategies and interventions that support managers in adopting EBM practices. Thirdly,
EBM practices can improve the quality of health care services provided by public health
institutions, which ultimately benefits patients and the public. By identifying the factors that
influence the adoption of these practices, it becomes possible to design effective policies and
programs that promote the practice of EBM. Lastly, research on EBM practices can contribute to
the broader field of management and organizational theory by providing insights into how EBM
practice can be implemented in different contexts. This knowledge is transferable to other fields
beyond public health institutions and can help to improve management practices in a wide range
of organizations. The findings will have implications for healthcare policy and practice,
particularly in terms of promoting evidence-based decision making among managers. The study
will also highlight the need for further research to explore the barriers to the adoption of EBM
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Methods
Population
Source Population
The source population will include all managers of public health institutions in Addis Ababa.
Study Population
All managers of public health institutions in Addis Ababa during the specified study period will
Study Variables
Dependent Variable
EBM practice
Independent Variables
Socio demographic information: age, sex, own computer, previous EBM training, place of
understanding of statistical terms used in EBM, leadership styles, perceived self-efficacy for
practicing EBM
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Organizational factors: access to information sources, organizational support, having time for
practicing EBM.
The sample size is determined by using a single population proportion formula (n = Z 2 P (1-
P)/d2) by taking 50% proportion of EBM practice with the following assumptions: 95% CI and
5% margin of error and by adding 10% none response rate. Where: n= sample size, Z= Z-vale at
95% confidence level (standard of 1.96), and d = margin of error 5% or (0.05). So based on the
formula, n = 1.96 2*0.5*(1-0.5)/ (0.05)2= 384. After adding 10% to account for non-respondents,
Sampling Technique
A stratified random sampling technique will be used to select participants from the selected
public hospitals in Addis Ababa. To get a representative sample of the study subjects from each
hospital, selection will be first stratified by data collection site. Then, considering their
Data will be collected using interview-administered questionnaire and document review. First,
the questionnaire is written in English and translated into the local language (Amharic). It is then
translated into English by language experts to ensure consistency. The questionnaire had five
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Data Quality Assurance
To assure the quality of data, a pre-test will be done on 5% of the sample in a similar setting
prior to the actual study. Two days of training on data collection tools and methods will be given
to the data collectors and supervisors. Data will be checked daily for completeness and accuracy.
After data collection, the questionnaire will be reviewed for completeness and consistency. Data
will be entered in Epi-Info version 7 and exported to SPSS software version 26 for analysis.
Descriptive statistics will be used to calculate mean, standard deviation and frequency. Tables
and graphs will be used to present the findings. Binary logistic regression analysis will be
performed to identify variables that are significantly associated with EBM practice. Then, all
independent variables with P-values less than 0.2 in bivariate analysis will be entered into
multivariate logistic regression to control confounding effects. Finally, variables with P-value
Ethical Considerations
Ethical clearance will be obtained from the Ethics Review Board of the University. An official
letter will be obtained from the University and will be communicated with selected public health
institutions. Participants will be asked to voluntarily participate in the study and will be informed
that they had the right to withdraw from the study at any time without notice. Data will be
collected only after briefly explaining the purpose of the study and obtaining informed consent
from each participant. Participants will be assured of confidentiality and their identifying
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