Linking Hospital Managers to the Literature: An Evidence-based Approach

ROBIN FEATHERSTONEApril 14, 2011

Your Information Seeking Behaviour

Origins of the Evidence-based Movement1990s: David Sackett et al. from McMaster coined the term, Evidence-based Medicine (EBM) Aimed to improve the quality of information used to make decisions

Migrated to other sectors - dentistry, nursing, management, etc.

What is Evidence-based Health Services Management (EBHSM)?Aids in the decision-making process Incorporates quality evidence from the literatureSeeks to evaluate managerial strategies and improve the performance of health services organizations (Kovner & Rundall, 2006)

Todays Objectivelearn to search for the best quality information to practice evidence-based decision-making in hospital management

How Questions Influence Search ResultsRelevancyRetrieval(# of search results)Broad QuestionsNarrow QuestionsHigh = lots of articlesLow = very few articlesHigh = directly relevant articlesLow = mostly irrelevant articles

Guidelines for Formulating a Question1- What management tool/technique are you thinking of using? 2- What process or outcome do you wish to achieve? 3- What is the setting?(Kovner & Rundall, 2006)

How do interdisciplinary teams function?

What workplace conditions are necessaryto support collaboration among members of interdisciplinary teams?From Thought to Question

Exercise 5 minutesIn pairs, develop a narrow question based on the following topics:

Transforming Care at the Bedside Patient flows

Levels of Evidence PyramidLevel 3: Single site studiesLevel 4: Descriptive studies/Case ReportsLevel 5. Expert OpinionMore TimeMore WorkMore EvidenceLevel 1: Systematic Reviews of Randomized Controlled TrialsLevel 2: Multicenter/Comparative studiesLess TimeLess WorkLess Evidence

Cochrane Library - DEMOContents

Cochrane Reviews-Approx. 4000 full-text reviews-Therapy, prevention and diagnosis informationOther Reviews -Approx. 16,000 abstracts-International coverage-Covers effects of clinical interventionsClinical Trials-Approx. 600,000 summaries of ongoing or completed clinical trials-International coverageMethods Studies-Summaries of reports of methods used in clinical trialsTechnology Assessments-Abstracts of studies assessing health care technologiesEconomic Evaluations-Abstracts and brief records of studies looking at costs and effects of competing healthcare interventions

ExerciseSearch the Cochrane Library to answer the question:

What are effective methods for increasing patient participation in clinical decision making?

Medline via PubMed - DEMOproduced by the National Library of Medicine (U.S.)indexes 5,500+ journals in the health sciencesprovides references and abstracts to journal articles

Using Subject HeadingsSearch each concept in your question separately

Mapping each of your concepts to a subject heading will find: the preferred search term in the database articles about your topic

Exercise

Find articles that discuss procedures for patient admissions from the ER

Tip: Break down the question into its separate concepts before searching.

What is the MeSH term for: Patient admissions?Emergency room?

Procedures?

SubheadingsUse to investigate specific aspects of your topic Narrows your search e.g., Patient Admission = ~15,600 results Patient Admission/methods = ~8 results Frequently used subheadings for management topics: /economics, /methods, /organization & administration, /statistics & numerical data

Combining search termsOR related terms for an individual concept; increases your search results e.g., tertiary care hospitals OR university teaching hospitals AND two/more concepts together to find relevant articles; decreases your search results e.g., re-engineering of jobs AND health care services PubMed DEMO: Find articles that discuss procedures for patient admissions from the ER

Applying limitsLanguage Year Age group Publication Type, etc.

Exercise

What are the costs involved to support teaching activities in a university teaching hospital?

15 minute break

Principles of Online SearchingDefine your question. Break down the question into its separate concepts. Search each concept separately.Combine search terms (AND/OR).Apply limits.Evaluate your results. Modify your search strategy if necessary.

ExerciseDoes organizational culture impact patient safety management?

About PubMed HSR Queries Filter An automated method to filter your PubMed search Limits your results to studies about health care quality and costs - Appropriateness of care - Process assessment - Outcome assessment - Costs - Economics - Qualitative research

Applying the HSR Queries Filter to your PubMed SearchCopy your PubMed search strategy.Go to PubMeds homepage.Click on the Topic-Specific Queries link.Click on the Health Services (HSR) Queries link.Paste your PubMed search strategy in the search box.

About ProQuest DatabasesContains:

Business references (ABI/INFORM, CBCA, Research Library) Company profiles (Hoovers) News sources (Canadian Newstand) Government and Industry Reports (Canadian Research Index)

ProQuest Databases Demo

ExerciseGo to http://muhclibraries.mcgill.ca/ adminguide.php . In pairs, search ProQuest Databases to answer the questions:

Does the implementation of Transforming Care at the Bedside impact on job satisfaction?

Who are Sodexo, Inc.s main competitors?

SummaryWhat resources will help you to find:

Systematic Reviews of RCTs?Process assessments?Company profiles?Newspaper articles?

Where would you place the following resources on the pyramid? PubMedCochrane LibraryProQuestHSR Queries filter

Summary contd.

Useful References on EBHSMReay T, Berta W, Kohn MK. What's the evidence on evidence-based management? Academy of Management Perspectives. 2009;23(4):5-18. Rousseau DM, McCarthy S. Educating managers from an evidence-based perspective. Academy of Management Learning & Education. 2007;6(1):84-101. Kovner AR, Rundall TG. Evidence-based management reconsidered. Frontiers of Health Services Management. 2006;22(3):3-22. Chan KS, Morton SC, Shekelle PG. Systematic reviews for evidence-based management: how to find them and what to do with them. American Journal of Managed Care. 2004;10(11 Pt 1):806-12. Walshe K, Rundall TG. Evidence-based management: from theory to practice in health care. Milbank Quarterly. 2001;79(3):429-57.

**0:05(5)*0:07(2)*. (continues from previous slide) are applied to decisions regarding business processes, operations, or strategic planning in order improve the performance of the organization. EBHSM encourages managers to base their decisions on well-conducted management studies whenever possible. If these studies do not exist on your topic, then make use of other sources of information, such as personal experience, experiences of others in other situations, existing data, etc.

Supplementary: Evidence based health services management applies the idea of evidence-based decision making to business process, operational, and strategic decisions in health services organizations. Whenever possible, health services managers should incorporate evidence into their decision making from well conducted management research studies. However, other sources of information and knowledge, such as personal experience, experiences of others in similar situations, expert opinion, and simple inspection of data trends and patterns, can and should be used if such information is the best available evidence for a given decision. Simply put, EBHSM is the systematic application of the best available evidence to the evaluation of managerial strategies for improving the performance of health services organizations (Kovner & Rundall, 2006, p. 6). This approach recognized that decision making is a process rather than a simple act of choosing among alternatives. 0:08(1)*0:10(1)*0:11(1)*0:12(1)*0:13(1)*0:19(6)*0:25(6)*0:40(15)*0:50(10)*0:52(2)*1:09(5)*1:04(8)*1:14(5)*1:19(5)*1:22(3)*1:30(8)*2:00(13)*1:45(15)*1:47(2)*2:07(5)*2:02(2)

*2:10(3)*******