Professional Documents
Culture Documents
Evidence-Based
Management
in Healthcare
Principles, Cases, and Perspectives
Foreword—David Blumenthal...................................................................xix
Acknowledgments......................................................................................xxi
An Introduction—Anthony R. Kovner and Thomas D’Aunno..................xxiii
Part I Overview
vii
viii B rief Co n te n ts
Foreword—David Blumenthal...................................................................xix
Acknowledgments......................................................................................xxi
An Introduction—Anthony R. Kovner and Thomas D’Aunno..................xxiii
Why Should Managers Read This Book?........................xxiii
Why Do We Care Passionately About Evidence-Based
Management?............................................................xxiii
What Did the First Edition Accomplish?.........................xxiv
What Do We Intend to Accomplish in the
Second Edition?..........................................................xxv
What Have We Not Yet Been Able to Accomplish?..........xxx
Part I Overview
xi
xii Det a iled C o n te n ts
Background...................................................................143
Initial Transformation of SCL Health CEO Evaluation
Policy and Practices ..................................................144
Disruptions to the System and the CEO
Evaluation Process ....................................................145
Reinstituting a Formal CEO Evaluation Process.............146
Case Study Questions.....................................................149
References......................................................................149
W
hen I was doing my medical residency, my fellow residents and I
could always identify the few master clinicians on the attending staff
in our teaching hospital.
They focused intently on their patients. Their questions were respect-
ful, artful, and precise, often eliciting that elusive historical fact that unlocked
a diagnostic puzzle. Their physical exams were incredibly skillful, as though
their fingers, eyes, and ears had extra dimensions of sensation. They mar-
shalled data from the patient’s history, the physical exam, laboratory results,
the scientific literature, their own personal experience, and something else—
intuition and wisdom—to reach an elegant synthesis and to formulate a
diagnostic and therapeutic plan.
As physicians in training, our (then hand-written) notes in the medical
records went on for pages. The master clinicians’ were only a paragraph or
two—yet they said more.
Are there the equivalent of master clinicians—master managers—on
the administrative side of the healthcare house? I hope and believe there
are. If so, one thing is absolutely clear: Among the skills they bring to their
craft is the ability to find and use the evidence that is relevant to the deci-
sions they must make. That evidence might come from a wide variety of
sources: their personal experiences and observations, the information sys-
tems in their organizations, the academic literature, and the teachings of the
clinical and nonclinical colleagues with whom they interact. But whatever
the evidence is, and wherever it is found, the master manager must be able
to master it.
Skeptics may point out that in the real world of management—at
the point of the spear—objective evidence is scarce and rarely sufficient to
identify a correct course of action. What’s more, the ability to marshal such
evidence is only one of many skills required for managerial excellence and
success. However, the same could be said of master clinicians, who rarely
have all the data they need when they must act. What master clinicians have
acquired is the ability to milk whatever data are available for everything
they’re worth.
xix
xx Fo rew o rd
Thanks to all the chapter authors and interviewees and the staff of Health
Administration Press—in particular Tulie O’Connor, who was invaluable in
the editing process, and Michael Noren, for his added value to the produc-
tion process.
xxi
AN INTRODUCTION
by Anthony R. Kovner and Thomas D’Aunno
This book is written for current and future healthcare managers, with the aim
of helping them reflect about whether they or their organizations are carrying
out their mission. Are the leaders asking appropriate questions? Are managers
learning which stakeholders to serve and how to serve those stakeholders bet-
ter? Asking the right questions is at the foundation of evidence-based man-
agement, or EBMgmt. Taking ownership of the evidence-based management
process adds value to any manager’s organizational contribution.
Analysis should always start with a truthful examination of how the
organization is functioning now and what problems or difficulties exist with
current operations. For example, what are our current hours of operation?
How many patients do we see in the ambulatory center each day we are open,
and each hour we are open? How many patients are on the waiting list, and
how much time do our providers spend with each patient? What activities
does the organization measure? What are the hours of operation of competi-
tors? What data do we collect, and how do we collect them? Who collects
the data? What would happen if we stayed open an hour later and started an
hour earlier, or if we opened during an evening or a Saturday or closed half
a day on another day? What is the cost of data analysis? What are the barriers
to intervention of a proposed implementation?
xxiii
xxiv A n I n t ro d u c ti o n
The first edition of this book, published in 2009, had four main accom-
plishments. First, it reviewed the movement from evidence-based medicine,
which was fairly well developed at the time, to the yet-to-be-fully-developed
application of evidence-based practice (EBP) to management. The coeditors
knew that, even though not all physicians practiced evidence-based medicine,
the evidence for what was best practice in management was scanty compared
to that in medicine.
Second, the book discussed then-current theories and definitions of
evidence-based management. Since the preparation of the first edition, the
terminology in the field has changed somewhat, with the phrase evidence-
based practice increasingly being used instead of evidence-based management.
A distinction between the two terms is that evidence-based management is
evidence-based practice carried out by managers rather than by clinicians,
lawyers, or policymakers.
Third, the book presented ten case studies of interventions using
evidence-based practice to respond to management challenges. In some
instances, EBP steps were used from the outset on a project; in other instances,
the EBP framework was applied retrospectively to interventions already under
way or completed. Some of the ten cases explicitly followed the steps of the
evidence-based process; others followed only some of the steps, or did not
report certain steps. Still, all of the cases illustrated how the basic principles of
evidence-based management were applied to a set of management challenges.
Fourth, the book presented research findings and conveyed what the
coeditors had learned about evidence-based management as of 2009, and it
discussed where the field could go from there. Richard D’Aquila observed
that the most important element was that management decisions be grounded
in a process whereby managers ask the right questions and assemble the right
information for a decision. This point may seem simple and logical, but
Another random document with
no related content on Scribd:
Valley of the Nile was regarded as a direct violation of the
rights of Egypt and Great Britain, and that, in accordance
with my instructions, I must protest in the strongest terms
against their occupation of Fashoda, and their hoisting of the
French flag in the dominions of His Highness the Khedive. In
reply, M. Marchand stated that as a soldier he had to obey
orders; the instructions of his Government to occupy the
Bahr-el-Ghazal and the Mudirieh of Fashoda were precise, and,
having carried them out, he must await the orders of his
Government as to his subsequent action and movements. I then
pointed out that I had the instructions of the Government to
re-establish Egyptian authority in the Fashoda Mudirieh, and I
asked M. Marchand whether he was prepared—on behalf of the
French Government—to resist the execution of these orders; he
must be fully aware, I said, that the Egyptian and British
forces were very much more powerful than those at his
disposal, but, at the same time, I was very averse to creating
a situation which might lead to hostilities. I therefore
begged M. Marchand to most carefully consider his final
decision on this matter. I further informed him that I should
be pleased to place one of the gun-boats at his disposal to
convey him and his expedition north. In answer to this, M.
Marchand did not hesitate to admit the preponderating forces
at my disposal, and his inability to offer effective armed
resistance; if, however, he said, I felt obliged to take any
such action, he could only submit, to the inevitable, which
would mean that he and his companions would die at their
posts. He begged, therefore, that I would consider his
position, and would allow the question of his remaining at
Fashoda to be referred to his Government, as, without their
orders, he could not retire from his position or haul down his
flag; at the same time, he said he felt sure that, under the
circumstances, the orders for his retirement would not be
delayed by his Government, and that then he hoped to avail
himself of the offer I had made him. I then said to him: 'Do I
understand that you are authorized by the French Government to
resist Egypt in putting up its flag and reasserting its
authority in its former possessions—such as the Mudirieh of
Fashoda?' M. Marchand hesitated, and then said that he could
not resist the Egyptian flag being hoisted. I replied that my
instructions were to hoist the flag, and that I intended to do
so. … The Egyptian flag was hoisted … at 1 P. M. with due
ceremony in the presence of the British and Egyptian troops,
and a salute of twenty-one guns was fired.
{200}
I should add that, in the course of the conversation, I
informed M. Marchand that, in addition to my verbal protest, I
intended to make a formal protest in writing, and this I duly
handed him before leaving Fashoda. During these somewhat
delicate proceedings nothing could have exceeded, the
politeness and courtesy of the French officers. Having
officially appointed Major Jackson Commandant of the Fashoda
district, and leaving with him a battalion of infantry, four
guns, and a gun-boat, I proceeded south with the remainder of
the troops and four gun-boats. …
EGYPT: A. D. 1898-1901.
The Barrage and Reservoir works on the Nile.
"At Assiut the great regulating dam across the Nile approaches
completion, the foundations being practically all in position,
leaving a portion of the superstructure to be completed. The
sluice openings here number 119, all 16 feet wide. This dam is
somewhat similar in principle to the well-known barrage near
Cairo, but the details of construction are entirely different,
as the foundations are guarded against undermining by a
complete line of cast iron and steel-piling above and below
the work. The barrage itself is constructed of high-class
masonry instead of brickwork as at the old barrage. Although
the Assiut barrage is overshadowed by the greater magnitude of
the Assuan dam, it will, doubtless, rank second as the
monumental work of Egypt."
ARTICLE I.
The word "Sudan" in this Agreement means all the territories
South of the 22nd parallel of latitude, which:
2.
Which, having before the late rebellion in the Sudan been
administered by the Government of His Highness the Khedive,
were temporarily lost to Egypt, and have been reconquered by
Her Majesty's Government and the Egyptian Government acting in
concert; or
ARTICLE II.
The British and Egyptian flags shall be used together, both on
land and water, throughout the Sudan, except in the town of
Suákin, in which locality the Egyptian flag alone shall be
used.
ARTICLE III.
The supreme military and civil command in the Sudan shall be
vested in one officer, termed the "Governor-General of the
Sudan." He shall be appointed by Khedivial Decree on the
recommendation of Her Britannic Majesty's Government, and
shall be removed only by Khedivial Decree, with the consent of
Her Britannic Majesty's Government.
{202}
ARTICLE IV.
Laws, as also Orders and Regulations with the full force of
law, for the good government of the Sudan, and for regulating
the holding, disposal, and devolution of property of every
kind therein situate, may from time to time be made, altered,
or abrogated by Proclamation of the Governor-General. Such
Laws, Orders, and Regulations may apply to the whole of any
named part of the Sudan, and may, either explicitly or by
necessary implication, alter or abrogate any existing Law or
Regulation. All such Proclamations shall be forthwith notified
to Her Britannic Majesty's Agent and Consul-General in Cairo, and
to the President of the Council of Ministers of His Highness
the Khedive.
ARTICLE V.
No Egyptian Law, Decree, Ministerial Arrêté, or other
enactment hereafter to be made or promulgated shall apply to
the Sudan or any part thereof, save in so far as the same
shall be applied by Proclamation of the Governor-General in
manner hereinbefore provided.
ARTICLE VI.
In the definition by Proclamation of the conditions under
which Europeans, of whatever nationality, shall be at liberty
to trade with or reside in the Sudan, or to hold property
within its limits, no special privileges shall be accorded to
the subjects of anyone or more Power.
ARTICLE VII.
Import duties on entering the Sudan shall not be payable on
goods coming from Egyptian territory. Such duties may,
however, be levied on goods coming from elsewhere than
Egyptian territory, but in the case of goods entering the
Sudan at Suákin, or any other port on the Red Sea Littoral,
they shall not exceed the corresponding duties for the time
being leviable on goods entering Egypt from abroad. Duties may
be levied on goods leaving the Sudan at such rates as may from
time to time be prescribed by Proclamation.
ARTICLE VIII.
The jurisdiction of the Mixed Tribunals shall not extend, nor
be recognized for any purpose whatsoever, in any part of the
Sudan, except in the town of Suákin.
ARTICLE IX.
Until, and save so far as it shall be otherwise determined, by
Proclamation, the Sudan, with the exception of the town of
Suákin, shall be and remain under martial law.
ARTICLE X.
No Consuls, Vice-Consuls, or Consular Agents shall be
accredited in respect of nor allowed to reside in the Sudan,
without the previous consent of Her Britannic Majesty's
Government.
ARTICLE XI.
The importation of slaves into the Sudan, as also their
exportation, is absolutely prohibited. Provision shall be made
by Proclamation for the enforcement of this Regulation.
ARTICLE XII.
It is agreed between the two Governments that special
attention shall be paid to the enforcement of the Brussels Act
of the 2nd July 1890, in respect to the import, sale, and
manufacture of fire-arms and their munitions, and distilled or
spirituous liquors.
EGYPT: A. D. 1899-1900.
Final defeat and death of the Khalifa.
Capture of Osman Digna.
Condition of the Sudan.
----------EGYPT: End--------
{203}
ELAM.
(in volume 4)
SEMITES;
ENGLAND: A. D. 1894.
The commandeering question with the South African Republic.
ENGLAND: A. D. 1894-1895.
Retirement of Mr. Gladstone from public life.
Earl of Rosebery Prime Minister.
His speech on the "predominant member" and Home Rule.
Weakening and overthrow of the Liberal Government.
Dissolution of Parliament.
Conservative and Unionist triumph.
Third Ministry of Lord Salisbury.
Mr. Gladstone, who had passed his 84th year, whose health was
failing, and who might justly consider that his public work
was done, resigned his post as Prime Minister, on the 2d of
March, 1894, and the Earl of Rosebery, on his recommendation,
was called by the Queen to take his place. Slight changes,
otherwise, were made in the cabinet, but the spirit in the
Liberal government was no longer the same. The new Premier
soon signified that his disposition in the matter of Home Rule
for Ireland was not quite what Mr. Gladstone's had been, by
using the following language in a speech (March 13) in the
House of Lords:
{204}
ENGLAND: A. D. 1895.
Enforcement of claims against Nicaragua.
See (in this volume)
CENTRAL AMERICA (NICARAGUA): A. D. 1894-1895.
ENGLAND: A. D. 1895.
The question of Chitral.
ENGLAND: A. D. 1896.
Establishment of the Sierra Leone Protectorate.
ENGLAND: A. D. 1896.
Report on Old-Age Pensions.