Evidence based

management (EBM)
Prepared by:
Dr. Seham Aly Mahmoud
Lecturer of nursing administration, Faculty of nursing, Tanta
University.
 Outlines
 Introduction
 Brief history of EBMgt
 Definition of EBM
 Source of evidence
 Process of EBM
 Barriers and facilitators of EBM
 Implications for nursing management
 Introduction
Healthcare organizations are complex and dynamic systems that
foster interactions between multiple factors related to patients,
healthcare teams, physical and social environments, as well as
organizational contexts, all of which impact the quality and
outcomes of care. With the wide array of problems facing the
healthcare sector today, such as the increase in the medical needs
of the community and the decrease in funding healthcare,
managers’ roles and the decisions they have to make are becoming
increasingly challenging.
• The adoption of EBMgt in this context is being seen as
a timely strategic step that could enable managers to
better cope with the complexity of healthcare
organizations by relying on the best available evidence
to improve their decision making, and consequently
achieve better organizational outcomes .
 Brief history of EBMgt
• EBMgt is an evolution in the practice of management and
organizations. The concept of EBM is a part of the broader
evidence-based practice movement, which began in the
medical science field in the late 1960s. It’s since spread to
many other specialized fields, including education, social
work, criminal justice, and management. Despite the
expectation of evidence-based practice in the clinical setting,
EBM remains a new concept in nurse management
 What is the meaning of EBMgt

• EBMgt could be defined as basing organizational

practices and managerial decisions on the best
available evidence. Similar to other evidence-
based practices, environmental factors and
ethical implications are also carefully considered
for managerial decisions
Evidence-based management (EBM) is about
making decisions through the conscientious,
explicit, and judicious use of the best available
evidence from multiple sources to increase the
likelihood of a favorable outcome”
• “Conscientious” here means that managers
make planned, thoughtful, and sustained
efforts to gather evidence from each of these
four sources. This is important because
otherwise the evidence which is easiest to get
will be used whether or not it is reliable or
relevant to the problem at hand.
• “ “Explicit” refers to being open and clear
about what evidence has been found and
communicating and recording it in a
comprehensible way. This is to help ensure that
all the evidence found is included, that those
involved have a shared understanding of this
evidence, and that any gaps can easily be
identified.
• Of course, not all information or evidence
is necessarily valid, relevant, or reliable
and so it requires careful “critical
evaluation” to determine, given the
problem or question in hand, the quality
and relevance of the evidence gathered.
EBMgt is the art of using the best for
achieving the best
 Sources of evidence

Stakeholders Experiential

Organizationa
scientific Critique the
Evidence
l
Valid .1
Reliable .2
Generalizable .3
Trustworthy .4
Applicable .5
 Sources of evidence

• The scientific literature Findings from empirical studies published

in academic journals.
• The organization Data, facts and figures gathered from the
organization performance improvement results, quality outcomes,.
Also, the organization goals and objectives.
• Practitioners The professional experience and judgment of
practitioners.
• Stakeholders The values and concerns of individual who may be
affected by the decision such as staff and patients gathered from
employee surveys or patient feedback surveys.
 EBM Process.
Asking ( form the question)

Acquiring (Systemically search the evidence)

Appraising (Critically evaluate the evidence.)

Aggregating (Synthesize the evidence weighing and pulling

together the evidence.)

Applying (Compare alternatives.)

Assessing’(Evaluate outcomes.)
 Steps towards an evidence-based nursing management

1) Formulating an answerable question: A clear question is

formulated addressing a current problem in nursing
management. For instance, what is the most effective way to
reduce nursing turnover?

2) Searching for evidence in the literature on management

as well as nursing management: After the question is
formulated, existing resources are researched for evidence
3) Critical appraisal of the research evidence: The validity
and applicability of the research evidence related to the
existing problem in nursing management are assessed.
4) The opinions of stakeholders and the ethical implications:
After the research evidence is critically evaluated, the views
of nurse managers and other managers would be considered
regarding the applicability of research evidence, and the
preferences of nurses would be discussed.
5) Decision making for implication: The strongest evidence
that stakeholders agree upon is chosen to be implemented
to solve the existing problem in nursing management.

6) The decision is implemented: The evidence-based

nursing management decision is implemented.

7) The results of evidence-based decision are evaluated: The

effectiveness of the EBNMgt implemented is evaluated in
terms of health care and working environment, and new
plans are made in light of this evaluation.
Barriers and facilitators of
evidence based
management (EBM)
• Although some studies have shown that health
leaders have a generally positive attitude toward
EBM, it was applied less than evidence-based
medicine in health organizations, so far. Managers do
not desire in applying evidence because of existing
different barriers, and they cannot overcome these
barriers and provide the facilitators to better
implementation of EBM in their organization.
• Therefore, providing a complete map of the EBM
facilitators and barriers in health systems can
provide a comprehensive view that can help
prioritize future efforts and promote the
implementation of EBM in the health systems
 Attitudes toward EBM
Barriers Facilitators
 Lack of  desire and political will
confidence/interest  Awareness and recognized
about the values or the need for change
accuracy of research  Confidence and trust about
data or the researchers research values
 Resistance to change
 Organizational factors
Barriers
 Bureaucracy and power
dynamics within traditional
organizational hierarchies
 Historical trends that impede
innovation uptake
 Organizational culture
opposed to EBMgt
 Lack of manager knowledge
and training about EBM.
Facilitators
 Strong leadership and
organizational support
 clear vision
 A receptive organizational culture
 Team collaboration &
communication
 Compensation and reward system
 Resources
Barriers Facilitators
 Inappropriate structure
 sufficient infrastructures or
 Inadequate funding for research
structures
or training
 Financial resources
 limited staff
 Allocate significant time for
 Time constrain
EBDM and timely
interpretation of data
 Suitable allocated staff
resources
 Policies and procedures
Barriers Facilitators
 Lack of clear system &
 Empowering the decision-
program to incorporate
maker and building capacity
evidence into decision
to use evidence in the
 Low evaluation or monitoring
decision-making process
 Inadequate training and
 Workforce development,
continuing education
empowerment and training
 Limited knowledge and skills
 Intervention audit and
evaluation
 Research capacity and data availability
Barriers Facilitators
 Lack of relevant or high-quality
 Relevance, reliable,
evidence”
interpretable and
 Inadequate/uneven access to
understandable evidence
evidence
 Focus on targeted research
 Lack of understanding & poor
utilization of research (how to  Targeted dissemination of

translate evidence into practice) results

 Excessive or scatter literature
to review.
 Implications for nursing management

• The implementation of EBNMgt is a multi-

dimensional and complex process therefore
necessary that the results of the research on
nursing management be applied in practice, and
managers and academics work together in
addressing the problems and generating solutions
to eliminate the gap between the theory and
practice of management.
 Implications for nursing management

• Researchers interested in nursing management

should take a closer look at the field of
practice in order to be able to better
address the practical problems faced. Nurse
managers should also seek ways to collaborate
with nurse researchers to be able to adopt a
scientific approach in solving managerial
problems.
 Implications for nursing management
• Collaboration between these two parties will create
synergy and facilitate the achievement of more effective
outcomes. Using collaborative models as a method
could facilitate implementing EBMgt in order to
improve the quality of health care and working
conditions. This collaboration will also help building an
evidence based culture. Like EBN, EBNMgt should also
be carefully studied for the professionalization of
nursing and better patient care.
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