Question

As you have examined this week, healthcare administration leaders are expected to exercise decision making under conditions of uncertainty. Perhaps more so than any other business, healthcare administration leaders face multiple challenges since ineffective business practices might not result in poor performance with their bottom lines and, if not, it might negatively impact patient safety. Understanding how to appropriately exercise decision making under conditions of uncertainty is a useful skill for effective healthcare administration practice.

Answer 1

The concept of evidence-based practice first emerged in clinical medicine and now suffuses the language, decision making, and standards of care of health care clinicians, managers, policy makers, and researchers throughout the world. Evidence-based clinical practice is defined as the conscientious, explicit, and judicious integration of current best evidence obtained from systematic research in making decisions about the care of individual patients.

The use of systematic research findings for evidence-based practice is also supported and applied in the fields of education, criminal justice, and social welfare through the efforts of the international Campbell Collaboration a sibling of the Cochrane Collaboration that prepares and maintains evidence-based systemic reviews of the effects of health care interventions.

While health care practitioners have been encouraged and supported in the adoption of evidence-based practice, the same support and encouragement has not been widely available to health care managers for multiple reasons:

1) Organizational research is sometimes esoteric and does not consistently address practical management questions. Further, research conducted on health care management is limited compared with management research in other industries. The main funders of research in health care have historically not funded management research. When large health systems have funded such research, its findings have often been considered proprietary and the results not widely published. As a result, little empirical evidence has been generated about best health care management practices.

2) The empirical evidence on effective management practices that does exist is difficult to locate. Management literature is poorly indexed for practical applications and is not easily reviewed and synthesized.

3) Many managers are not trained or experienced in the use of such evidence in making management decisions. While physicians are trained in a strongly professional model with fairly uniform educational preparation, managers come from a variety of very different professional backgrounds and training. Some management training comes more from long-term practical experience in the workplace, as opposed to formal professional education.

4) Although many health systems spend millions of dollars on consultants for strategic recommendations based on data, they typically under-fund their own data systems designed to support decision making and internal management research. A study of 14 U.S. hospitals implementing re-engineering initiatives in the 1990s found that existing operating budgets often were used to measure progress in meeting re-engineering goals, but did not contain baseline statistics managers could use for comparative purposes or identification of causes and effects.

5) Some HCOs lack sufficient size and resources to conduct and evaluate applied research.

6) Managers' decision-making practices are often quite different from those of health care practitioners. While practitioners' decisions are many in number and made independently, management decisions are often few, large, and made by groups, involving negotiation or compromise and many organizational constraints.