Promoting evidence-based management.

HEALTHCARE EXECUTIVES, working with their clinical teams, need to use the best available evidence to ensure that care is safe, effective, efficient, timely, patient-centered, and equitable-the six aims of any health system as outlined by the Institute of Medicine (2001). Kovner and Rundall provide further evidence that this does not occur as frequently as it should. They go on to identify various sources of evidence that could be used, describe normative models for such use, and provide some useful suggestions for improving the use of management research evidence in the decision-making process. In this commentary, I call attention to the importance of knowledge brokers, discuss the new types of evidence that managers will need to draw on, highlight the importance of governing boards, and offer some specific recommendations for expanding the use of evidence-based managerial research. Figure 1 provides a simplified model showing two pathways in which evidence-based management research might be used by healthcare decision makers. The first pathway depicts the direct relationship between the producers of the research and the users. Recommendations to the research community (Canadian Health Services Research Foundation 2000) have included: 1. Exorting researchers to involve the users early on in the research process; 2. Encouraging researchers to provide preliminary findings in time to be useful to decision makers; 3. Writing the results in clear, understandable language; and 4. Making in-person presentations explaining what the findings mean for practice. In the feature article, Kovner and Rundall also offer several suggestions to improve the organization's use of evidence-based management research including designating specific individuals within the organization to routinely summarize relevant literature, developing a "questioning" culture, linking compensation to use of research, and participating in management research. However, Kovner and Rundall suggest that this direct pathway from producer to user may be of limited utility as managers report getting much of the information that they use in decision making from talking with consultants and others, and through the Internet, conferences, and related sources (see pathway 2 in Figure i). These entities might be called "knowledge brokers." Thus, a more effective approach to improve the use of evidence-based management research in healthcare decision making might be to strengthen the second pathway operating through the knowledge brokers. This will require a stronger connection between the research community and knowledge brokers on the one hand and between the knowledge brokers and the users on the other hand. Simply put, researchers are likely to get more traction in influencing managerial decision making by working with consultants and thought leaders, making conference presentations, and speaking with the media (both print and video), supplemented by posting the findings on the Internet. Disadvantages to this approach include the likelihood that, to some extent, the knowledge brokers may misinterpret the study findings, exaggerate their applications, or claim them as their own. It has been my experience and that of other investigators with whom I have spoken that developing ongoing relationships with targeted respected consultants, thought leaders, and reporters minimizes these potential disadvantages. Careful cultivation of these relationships can create a "tipping point" in which research emerges in the world of practice as "something to pay attention to" and as "ideas in currency." Healthcare executives begin to draw on the findings and data in making decisions and in rationalizing decisions after they are made. To strengthen the pathway between the knowledge brokers and healthcare decisionmaker community requires forums in which these parties can dialog. Research is always context-specific such that the results always need to be adapted to specific environments and to specific organizations, which almost always differ from the environment and organization that participated in the research. …