Health Care Management "Culture eats strategy."

The Business Case for Evidence-Based Management

Management literature across all disciplines points to the critical importance of quality decision-making. A fundamental practice problem for decision makers is that the information that is readily available or accessible may be incomplete, outdated, and/or not based on evidence. Quality decision-making is dependent on access to and use of quality information. That is to say that, the old adage used by the early computer scientists -- "garbage in, garbage out" -- is applicable to management decision-making. This tenet is pivotal to management in healthcare for reasons that span the high stakes patient care decisions to the survival of medical institutions in a punishing fiscal environment.

In the service-oriented organizations of healthcare, decisions are part of an interwoven network -- a fabric that encompasses the administrative, operational, and patient care aspects as a unified entity. Poor decisions made in any single business or care unit in a healthcare facility can create waves of repercussions that are felt throughout the institution.

In their review of the Shewhart Plan-Do-Study-Act cycle and the generic eight-step decision-making model, Kovner and Rundall (2006) argue that important considerations are missing from both. The treatment of data gathering and fact finding lacks depth. Decision-making is strengthened when it is derived from a well-rounded and in-depth gathering process that includes data and information from local sources, from current evidence-based best practices, from clinical experience, and is informed by benchmarking to other comparable institutions. Additionally, Kovner and Rundall (2006) would like to see decision-making models...

An evidence-based approach is typically a five-step process: 1) Identify the research question; 2) access and review the relevant research and evidence; 3) evaluate the relevance, applicability, quality, and validity of the information; and 4) present the findings in a manner that is actionable and persuasive. Applying this process to the hospital setting, the evidence-based process overlays a root cause analysis (RCA) to this problem of practice. This means that the following questions are asked -- and answered, as much as possible, by providing evidence: 1) What happened? 2) What should have happened? 3) Why did it happen? And 4) What can be done to correct the error? (Percapio, et al., 2008 as cited in Lambton & Mahlmeister, 2010).
Consideration of the Problem

In a large academic medical center, it has come to light that patients who have Do Not Resuscitate (DNR) orders sometimes do not receive the level or scope of palliative care that could -- and most likely should -- be provided. Under these conditions, patients suffer needlessly and family members have begun to complain and register unfavorable remarks on websites and social media networks. As a nurse in the acute care unit, my primary concern related to this matter is that patients at end-of-life are not receiving the quality of care that hospital identifies as central to its mission. The purpose of this discussion is to identify the network of variables that create and sustain the problem, and to provide evidence-based practice solutions to change and manage the situation.

The members of the hospital staff have expressed concern that the problem seems to…