Evidence-Based Management Practice and Associated Factors Among Managers of

Selected Public Health Institutions in Addis Ababa, Ethiopia

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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

an evidence-based management (EBM) when making decisions.

EBM is an approach to healthcare 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, a critical assessment of

the best available research evidence, and the perspectives of that population who might be

affected by the organizational decisions. 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 experience

of administrators also constitute ‘evidence’. The practice of EBM is 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. Therefore, hospital managers are forced

to practice EBM in order to attain the effective management.

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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 Often, decisions are based on incomplete and outdated information and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. Therefore, using evidence in the decision-making process can lead to

improving the quality of managerial decisions. Managers should make effective and efficient

decisions that lead to better productivity of the organization, and the accurate and precise use of

best evidence from different sources for increasing the outcomes is the result of EBM.

Healthcare managers decisions have a significant impact on the effectiveness of delivering

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

institutions continue to face significant challenges in implementing it effectively. Moreover,

EBM has been slowly adopted by healthcare managers. 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

will be useful in guiding decision-making, policy formulation and implementation, and

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

these practices by managers in public health institutions.

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

practice in healthcare management among managers of public health institutions

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Literature review

The Magnitude of EBM Practice

Factors Associated with the Practice of EBM

A study conducted to explore attitudes and identify perceived barriers regarding the practice of

EBM among healthcare managers in Saudi Arabia showed that a lack of EBM training, lack of

time, limited understanding of scientific research, and a lack of organizational support and

culture for implementing the EBM approach were the major hindering the practice of EBM.

Similarly, a study conducted to identify factors affecting the adoption of EBM among U.S

healthcare administrator revealed that lack of training, unfamiliarity with EBM, lack of skills to

critically appraise quality of evidence, and lack of organizational support were the factors

hindering the adoption of EBM.

A study conducted to explore attitudes and identify perceived barriers regarding the practice of

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

limited understanding of scientific research and a lack of organizational support and culture for

practicing EBM were the most common factors hindering the practice of EBM. Similarly, a study

conducted to identify factors affecting the adoption of EBM among U.S healthcare administrator

found that a lack of training was one of the top four barriers that prevented the practice of

EBMgt 24 Researchers have suggested that training in EBMgt would increase healthcare

managers’ competencies in making better decisions using research evidence.25,26

A study conducted to explore attitudes and identify perceived barriers regarding the practice of

EBM among healthcare managers in Saudi Arabia showed that lack of time were one of the most

common factors hindering the practice of EBM. Healthcare management is a complex

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profession, as it must consider the interests of the organization and patients. This keeps managers

very busy, with no time to educate themselves on updated information in the management field.

Pfeffer and Sutton stated it is difficult for managers to adopt EBMgt, as there is too much

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

EBMgt.19

Limited understanding of scientific research was perceived to be one of the major barriers to the

practice of EBM. Consistently, the results of the study of Barend et al., indicated that the

inability to interpret scientific research is an important barrier facing managers to practice

EBM.15

Janati et al. stated that to improve the utilization of EBMgt, hospital leaders need to promote a

culture that allows managers to dedicate time to searching and consulting scientific evidence.3

However, a lack of organizational culture and support for implementing evidence-based decision

making was found to be one of the leading barrier to practice EBM. The same barrier was also

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

a potential barrier experienced by healthcare managers.29

Furthermore, other studies indicated that a lack of organizational resources and limited access to

scientific research were reported to be the major barriers to the practice of EBM.15,29 This could

be because the hospital provides free access to online databases that contain a variety of articles

from academic and scientific journals. Several factors exist at the organizational and personal

level that prevent the adoption of EBMgt. To reduce these barriers, efficient ways of integrating

evidence-based decision making into organizational processes are needed. The findings of this

study provide policymakers and healthcare leaders with baseline information on barriers

affecting the adoption of EBMgt among healthcare managers. In addition, the outcome of this

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study could be useful for researchers to explore possible interventions that might increase the use

of evidence-based approaches and reduce perceived barriers to the adoption of EBMgt for better

decision making among healthcare managers.

Methods

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.

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

be the study population.

Study Variables

Dependent Variable

EBM practice

Independent Variables

Socio demographic information: age, sex, own computer, previous EBM training, place of

studying and internet access.

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Individual factors: preferences of information sources, awareness of EBM resources,

understanding of statistical terms used in EBM, leadership styles, perceived self-efficacy for

practicing EBM

Organizational factors: access to information sources, organizational support, having time for

practicing EBM.

Sample Size Determination and Sampling Technique

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.

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

proportion of the population, simple random sampling method was applied.

Data Collection Tools

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

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translated into English by language experts to ensure consistency. The questionnaire had five

sections: participants' demographic characteristics, individual factors, clinical factors, health

system-related factors and antihypertensive medication adherence.

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.

Data Processing and Analysis

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

less than 0.05 will be considered significantly associated factors.

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.

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