Professional Documents
Culture Documents
EBMgt Final
EBMgt Final
Ababa, Ethiopia
By:
Advisor:
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Table of Contents
1. Introduction ............................................................................................................................. 4
3. Objectives ................................................................................................................................ 9
4. Methods ................................................................................................................................. 10
4.2 Population............................................................................................................................ 10
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4.4.2 Sampling Technique ..................................................................................................... 11
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
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
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
Despite the increasing emphasis on EBM to achieve effective management, many public health
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
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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
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
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2. Literature Review
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
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
and do not have time to educate themselves on the latest management information. Pfeffer and
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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
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
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
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3. Objectives
To assess the magnitude of EBM practice and Associated factors among managers of public health
• To assess the magnitude of EBM practice among managers of public health institutions in
• To identify factors associated with the practice of EBM among managers of public health
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4. Methods
4.2 Population
The source population will include all managers of public health institutions in Addis Ababa.
All managers of public health institutions in Addis Ababa during the specified study period will be
Socio-demographic factors: age, sex, educational status, marital status, own computer, EBM
EBM resources, understanding of statistical terms used in EBM, leadership styles, perceived self-
Organizational factors: access to EBM information sources, organizational support, having time
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4.4 Sample Size Determination and Sampling Technique
The sample size is determined by using a single population proportion formula (n = Z2 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
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
Data will be collected using self-administered questionnaire. The questionnaire has four sections;
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.
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.
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 information will
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5. References
2. Guo R, Hermanson PM, Farnsworth TJ. Study on hospital administrators' beliefs and
66. doi:10.1080/00185868.2016.125888.
4. Stefl M. Common competencies for all healthcare managers: the Healthcare Leadership
200811000-00004.
5. Pfeffer J, Sutton R. Hard facts, dangerous half-truths, and total nonsense: profiting from
Manage. 1998;1751:307–17.
2017;12(10):e0184594. doi:10.1371/journal.pone.0184594
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9. Guo R, Berkshire SD, Fulton LV, Hermanson PM. Factors affecting the adoption of
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.
12. Willmer M. How nursing leadership and management interventions could facilitate the
doi:10.1111/j.1365-2834.2007.00751.x.
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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