Postgraduate Course
Evidence based management:
Where does it come from?
What field is this?
Postgraduate Course
 “there is a large research-user gap”
 “practitioners do not read academic journals”
 “the findings of research into what is an effective intervention
are not being translated into actual practice”
 “academics not practitioners are driving the research agenda”
 “the relevance, quality and applicability of research is
questionable”
 “practice is being driven more by fads and fashions than
research”
 “many practices are doing more harm than good”
Medicine: Founding fathers
Postgraduate Course
David Sackett
Gordon Guyatt
McMaster University Medical School, Canada
How it all started
Postgraduate Course
Problem I: too much information
Postgraduate Course
 More than 1 million articles in 40,000 medical journals per
year (= 1995; now probably more than 2 million). For a
specialist to keep up this means reading 25 articles every
day (for a GP more than 100!)
 Most of the new insights and treatment
methods don’t reach the target group
Problem I: too much information
Postgraduate Course
 HRM: 1,350 articles in 2010 (ABI/INFORM). For an HR
manager to keep up this means reading 3 to 4 articles
every day (for a ‘general’ manager more than 50!)
Problem II: persistent convictions
Postgraduate Course
if you’re
hyperventilating
breathe into a bag
Problem III: jumping to conclusions
Postgraduate Course
elderly people who have
an irregular heartbeat are
much more likely to die of
coronary disease
give them a drug that
reduces the
number of
irregular beats
How 40,000 cardiologists can be wrong
Postgraduate Course
In the early 1980s newly introduced antiarrhythmic drugs were found to be highly
successful at suppressing arrhythmias.
Not until a RCT was performed was it realized
that, although these drugs suppressed
arrhythmias, they actually increased mortality.
The CAST trial revealed Excess mortality of
56/1000.
By the time the results of this trial were
published, at least 100,000 such patients had
been taking these drugs.
Postgraduate Course
David Sackett
 Half of what you learn in medical school will be
shown to be either dead wrong or out-of-date
within 5 years of your graduation; the trouble is that
nobody can tell you which half.
 The most important thing to learn is how to learn
on your own.
 (Remember that your teachers are as full of bullshit
as your parents)
Evidence-Based Practice
Postgraduate Course
1991
Medicine
1998
Education
1999
Social care
2000
Nursing
2000
Criminal justice
????
Management?
Postgraduate Course
Management: Founding Mother
Postgraduate Course
Management: Founding Fathers
Postgraduate Course
Jeffrey Pfeffer
Robert Sutton
Evidence based decision
Postgraduate Course
“Good managers use both individual managerial
expertise and the best available external evidence, and
neither alone is enough. Without managerial expertise,
practice risks becoming tyrannized by evidence, for even
excellent external evidence may be inapplicable to or
inappropriate for an individual organization or team.
Without current best evidence, practice risks becoming
rapidly out of date, to the detriment of organizations and
employees.”
Evidence based decision
Postgraduate Course
Individual Managerial Expertise
 Managerial skills and managerial judgment
 Vital for determining whether the evidence applies
to an individual organization (division, team) at all
and, if so, how
5-step approach
Postgraduate Course
EBMgt is a 5-step approach
1. Formulate an answerable question (PICOC)
2. Search for the best available evidence
3. Critical appraise the quality of the found evidence
4. Integrate the evidence with managerial expertise
and organizational concerns and apply
5. Monitor and evaluate the results