Evidence-Based Management Practice and Associated Factors

Among Managers of Selected Public Health Institutions in Addis

Ababa, Ethiopia

By:

Advisor:

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Table of Contents

1. Introduction..............................................................................................................................4

1.1 Background............................................................................................................................4

1.2 Statement of the Problem.......................................................................................................5

1.3 Rationale and Significance of the Study................................................................................6

2. Literature Review.....................................................................................................................7

2.1 Factors Associated with EBM Practice..................................................................................7

3. Objectives.................................................................................................................................9

3.1 General Objective..................................................................................................................9

3.2 Specific Objectives................................................................................................................9

4. Methods..................................................................................................................................10

4.1 Study Design, Area and Period............................................................................................10

4.2 Population............................................................................................................................10

4.2.1 Source Population..........................................................................................................10

4.2.2 Study Population...........................................................................................................10

4.3 Study Variables....................................................................................................................10

4.3.1 Dependent Variable.......................................................................................................10

4.3.2 Independent Variables...................................................................................................10

4.4 Sample Size Determination and Sampling Technique.........................................................11

4.4.1 Sample Size Determination...........................................................................................11

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 4.4.2 Sampling Technique......................................................................................................11

4.5 Data Collection Tools..........................................................................................................11

4.6 Data Quality Assurance.......................................................................................................11

4.7 Data Processing and Analysis..............................................................................................12

4.8 Ethical Considerations.........................................................................................................12

5. References..............................................................................................................................13

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1. Introduction

1.1 Background

Health care management is a profession that provides leadership and guidance to organizations

that provide personal health care services and to divisions, departments, units, or services within

those organizations. Accordingly, health care managers are decision-making leaders who lead

and manage health care organizations at different levels [1]. Such decisions have a significant

impact on the effectiveness of the healthcare delivery process and the success of healthcare

organizations. Ensuring the quality and safety of health care delivery, cost-effectiveness and

efficiency requires the hospital manager to practice evidence-based management (EBM) in

decision-making [2].

EBM is an approach to health care management that involves making managerial decisions

through the conscientious, explicit, and judicious use of four sources of information:

administrator expertise and judgment, evidence from the local context, critical assessment of the

best available research evidence, and the perspective of the population that might be influenced

by organizational decisions [3]. The core concept of EBM is that high-quality decisions require

both critical thinking and the use of "best available evidence." This "evidence" may come from

scientific research, but "evidence" also consists of internal hospital information and even the

professional experience of administrators. The practice of EBM is considered one of the

necessary competencies for the effective management of modern healthcare organizations and

proposed managerial competencies that include the acquisition, evaluation and implementation

of scientific research findings for managerial decisions [4]. Therefore, health care managers are

forced to practice EBM to achieve effective management.

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1.2 Statement of the Problem

Healthcare settings are complex; as a result, the types of decisions that need to be made are

usually complicated as well. Often decisions are based on incomplete and outdated information

and personal experience [5]. The use of evidence in the decision-making process can therefore

lead to an improvement in the quality of managerial decisions [6]. Healthcare managers should

make effective and efficient decisions that lead to better organizational productivity, and accurate

and precise use of the best evidence from various sources to increase outcomes is the result of

EBM [7]. The decisions of healthcare managers have a significant impact on the effectiveness of

providing quality patient care and the success of healthcare organizations. Therefore, it is

important for health care managers to acquire EBM knowledge and skills and adopt EBM as best

practices in decision-making to improve the quality of patient care and availability of health

services and reduce health care costs.

Despite the increasing emphasis on EBM to achieve effective management, many public health

institutions continue to face significant challenges in its effective implementation. In addition,

EBM was slowly adopted by health care managers [8]. To strengthen the implementation of

EBM, it is necessary to ascertain the current state of EBM practice and to identify the factors

influencing EBM practice [8]. However, there is limited knowledge about the extent of adoption

and factors influencing the practice of EBM among managers of Ethiopian public health

institutions. This study seeks to fill this gap by examining the status of EBM practices and

related factors among managers of public health institutions in Addis Ababa. This information

will be useful in decision making, policy formulation and implementation and ultimately to

improve the quality of health services provided by public health institutions.

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1.3 Rationale and Significance of the Study

There are several rationales and importance for conducting research on EBM practices and

related factors among managers of public health institutions. First, EBM practices have been

shown to contribute to the effectiveness and efficiency of public health institutions. These

procedures are based on rigorous scientific research and use objective data as a basis for decision

making. Therefore, it is important to understand the factors that facilitate or hinder the adoption

of these practices by managers in public health facilities.

Second, research on EBM practices can provide insight into the challenges managers face 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. Third,

EBM practices can improve the quality of health care services provided by public health

institutions, ultimately benefiting both patients and the public. By identifying the factors that

influence the adoption of these practices, it is possible to design effective policies and programs

that support the practice of EBM. Finally, research on EBM practices can contribute to the

broader field of management and organization theory by providing insight into how EBM

practice can be implemented in different contexts. This knowledge is transferable to areas

outside of public health institutions and can help improve management practices in a wide range

of organizations. The findings will have implications for health policy and practice, particularly

in terms of supporting evidence-based decision-making among managers. The study will also

highlight the need for further research to examine barriers to the adoption of EBM practices in

healthcare management among managers of public healthcare institutions.

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2. Literature Review

2.1 Factors Associated with EBM Practice

A study conducted to explore attitudes and identify perceived barriers to EBM practice among

healthcare managers in Saudi Arabia showed that lack of EBM training, lack of time, limited

understanding of scientific research, and lack of organizational support and culture for

implementing an EBM approach were the main barriers to EBM practice [8]. Similarly, a study

conducted to identify factors influencing EBM adoption among US health care administrators

revealed that lack of training, ignorance of EBM, lack of skills to critically appraise the quality

of evidence, and lack of organizational support were factors hindering EBM adoption [9].

A study conducted to explore attitudes and identify perceived barriers to EBM practice among

healthcare managers in Saudi Arabia showed that lack of training, lack of time, limited

understanding of scientific research, and lack of organizational support and culture for practicing

EBM were the most common factors hindering EBM practice. Similarly, a study conducted to

identify factors influencing EBM adoption among healthcare administrators in the US found that

lack of training was one of the top barriers to EBM practice [9]. Researchers suggested that

training in EBM would increase the competence of healthcare managers in making better

decisions using research evidence [10, 11].

A study conducted to explore attitudes and identify perceived barriers to EBM practice among

healthcare managers in Saudi Arabia showed that lack of time was one of the most common

barriers to EBM practice. Healthcare management is a complex profession because it must take

into account the interests of the organization and the patients. As a result, managers are very busy

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and do not have time to educate themselves on the latest management information. Pfeffer and

Sutton stated that it is difficult for managers to adopt EBM because there is too much

information for any manager to consume and lack of time is a major barrier to EBM practice

[12]. Limited understanding of scientific research was perceived as one of the main barriers to

EBM practice. The results of the study by Barend et al. have consistently indicated that the

inability to interpret scientific research is an important barrier that managers face in

implementing EBM [8].

Evidence have shown that to improve the practice of EBM, hospital leaders must foster a culture

that allows managers to spend time seeking and consulting scientific evidence [7]. However, lack

of organizational culture and support for the implementation of evidence-based decision-making

was found to be one of the main barriers to the application of EBM. The same barrier was also

identified in another study where a lack of organizational culture and support was found to be a

potential barrier faced by healthcare managers [13].

In addition, studies have shown that lack of organizational resources and limited access to

scientific research have been reported as major barriers to EBM practice [8-10]. This may be

because the hospital provides free access to online databases that contain various articles from

academic and scientific journals. At the organizational and personal level, there are several

factors that hinder the adoption of EBM. Effective ways of integrating evidence-based decision-

making into organizational processes are needed to reduce these barriers.

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3. Objectives

3.1 General Objective

To assess the magnitude of EBM practice and Associated factors among managers of public

health institutions in Addis Ababa, Ethiopia.

3.2 Specific Objectives

 To assess the magnitude of EBM practice among managers of public health institutions in

Addis Ababa, Ethiopia.

 To identify factors associated with the practice of EBM among managers of public health

institutions in Addis Ababa, Ethiopia.

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4. Methods

4.1 Study Design, Area and Period

An institution-based cross-sectional study will be conducted at selected public health institutions

in Addis Ababa from June to July 2023.

4.2 Population

4.2.1 Source Population

The source population will include all managers of public health institutions in Addis Ababa.

4.2.2 Study Population

All managers of public health institutions in Addis Ababa during the specified study period will

be the study population.

4.3 Study Variables

4.3.1 Dependent Variable

The dependent variable is EBM practice.

4.3.2 Independent Variables

Socio-demographic factors: age, sex, educational status, marital status, own computer, EBM

training, religion, monthly income.

Individual factors: preferences of information sources, knowledge about EBM, awareness of

EBM resources, understanding of statistical terms used in EBM, leadership styles, perceived

self-efficacy for practicing EBM.

Organizational factors: access to EBM information sources, organizational support, having

time for practicing EBM.

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4.4 Sample Size Determination and Sampling Technique

4.4.1 Sample Size Determination

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,

the final sample size is 422.

4.4.2 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 place of working. Then, considering their proportion

of the population, simple random sampling method will be applied.

4.5 Data Collection Tools

Data will be collected using self-administered questionnaire. The questionnaire has four sections;

socio-demographic, EBM practice, individual factors and organizational factors.

4.6 Data Quality Assurance

The quality of the data will be assured through careful design and pretesting of the tools, proper

training of the data collectors and supervisors. One day training will be provided for the data

collectors on how the data should be obtained and recorded. The training will be given on the

topics; study objectives, the questionnaire, the use of survey instruments, interview techniques,

and direction as to how to interview the respondents using the structured questionnaire. The

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principal investigator and supervisors will make continuous follow-up and supervision

throughout the data collection period. In addition, regular check-up for completeness and

consistency of the data will be made on daily basis. Pre-test will be conducted in a similar setting

before the actual data collection time on 5% of the sample size in order to check the reliability of

the instrument and to modify the questionnaire accordingly. Using the data obtained from the

pre-test, the questionnaire will be checked for reliability (internal consistency) using the

Cronbach alpha test.

4.7 Data Processing and Analysis

The collected data will be cleaned, coded, and entered in to Epi-info version 7.2 and SPSS

version 26 for further analysis. Descriptive statistics, including frequencies, mean (SD)/median

(IQR), and percentages will be computed to summarize the data. Binary logistic regression

model will be fitted to identify factors associated with EBM practice. Initially, bivariate analysis

will be performed to identify candidates for multivariable binary logistic regression analysis.

Then, variables with a p-value less than 0.25 will be selected to be considered for multivariable

analysis. Finally, variables having significant associations with EBM practice will be identified

based on Adjusted Odds Ratio (AOR), with a 95% confidence interval (CI) and a P- value less

than 0.05.

4.8 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

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from each participant. Participants will be assured of confidentiality and their identifying

information will not be shared with anyone not directly involved.

5. References

1. Buchbinder S, Shanks N. Introduction to Health Care Management. Burlington, MA:

Jones & Bartlett Learning; 2017.

2. Guo R, Hermanson PM, Farnsworth TJ. Study on hospital administrators' beliefs and

attitudes toward the practice of evidence-based management. Hosp Top. 2016;94(3-4):62-

66. doi:10.1080/00185868.2016.125888.

3. A definition of evidence-based management – center for evidence based management

[Internet]. Available from: https://cebma.org/a-definition-of-evidence-based-

management/

4. Stefl M. Common competencies for all healthcare managers: the Healthcare Leadership

Alliance Model. J Healthc Manag. 2008;53(6):360-373. doi:10.1097/00115514-

200811000-00004.

5. Pfeffer J, Sutton R. Hard facts, dangerous half-truths, and total nonsense: profiting from

evidence-based management. Boston: Harvard Business Press; 2006.

6. Axelsson R. Towards an evidence-based health care management. Int J Health Plann

Manage. 1998;1751:307–17.

7. Janati A, Hasanpoor E, Hajebrahimi S, Sadeghi-Bazargani H. Health care managers’

perspectives on the sources of evidence in evidence-based hospital management: a

qualitative study in Iran. Ethiop J Health Sci. 2017; 27(6):659.

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8. Barends E, Villanueva J, Rousseau D et al. Managerial attitudes and perceived barriers

regarding evidence-based practice: An international survey. PLoS ONE.

2017;12(10):e0184594. doi:10.1371/journal.pone.0184594

9. Guo R, Berkshire SD, Fulton LV, Hermanson PM. Factors affecting the adoption of

evidence-based management among U.S. healthcare administrators. American Journal of

Management. 2018;18(1):36-47. doi:10.33423/ajm.v18i1.30.

10. Shortell S. Promoting evidence-based management. Front Health Serv Manage.

2006;22(3):23-30. doi:10.1097/01974520200601000-00003.

11. Walshe K, Rundall T. Evidence‐based management: from theory to practice in health

care. Milbank Q. 2001;79(3):429-457. doi:10.1111/1468-0009.0021.

12. Willmer M. How nursing leadership and management interventions could facilitate the

effective use of ICT by student nurses. J Nurs Manag. 2007;15(2):207-213.

doi:10.1111/j.1365-2834.2007.00751.x.

13. Humphries S, Stafinski T, Mumtaz Z, Menon D. Barriers and facilitators to evidence-use

in program management: a systematic review of the literature. BMC Health Serv Res.

2014;14(1). doi:10.1186/1472-6963-14-171.

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