.. If one of the goals of the healthcare system is to promote health and prevent illness and injury, it may be logical to start with those who work in the system." (Yassi, Ostry, Spiegel, and Walsh, 2002, p.1)
Presently the healthcare environment is characterized by nurse shortages of 25% of the entire nursing force. It is held that the working conditions along with job stress negatively impact the nursing force and its turnover rate. Injuries are also reported by nursing staff. It is likely that the nursing shortage is the number one challenge in today's healthcare provision. The negative work environment negatively impacts the nursing professional and their decision to either leave or to potentially fail altogether to enter the profession.
Naturally when there is a shortage of any type of professional worker some area suffers their absence and when this concept is applied in the field of healthcare provision it is certain that the outcomes for the patient/consumer is negatively impacted. Therefore, it would appear that management that is based in evidence and specifically from this the view expressed in the work of Yassi, Ostry, Spiegel, and Walsh (2002) is that the role of the nurse is so very critical and vital to patient outcomes that the starting point of evidence-based practice is in the area of management of the healthcare provider workforce. (2002, paraphrased)
The work of Rundall (2002) entitled: "Evidence-Based Management in Healthcare: Lessons from Clinical Practice: reports a research study that had as its objective the development of an analytic framework for comparison of decision-making processes in clinical practice to those in health management and policy arenas, and to explore the potential for the development of evidence-based approaches to health management and health policy." (Rundall, 2002, p.1)
Rundall states that the study was based on an extensive review of the relevant literature. (2002, p.1) Evidence-based clinical practice is stated by Rundall (2002) to have "made great strides and important changes in the way clinicians make decisions..." (p.1) Additionally stated is that the managers and policymakers "have been prominent advocates of evidence-based clinical practice, but have not been quick to apply the same principles to their own decision making. When health policy development and managerial practice are examined, it is evident that many examples of a research/practice gap can be identified. The appropriate use of research evidence in management and policy decision making could improve quality and performance in health systems, but important differences in the culture, research base and decision making process exist and need to be taken into account." (Rundall, 2002, p.1) Rundall (2002) concludes by stating that if "...a more evidence-based approach to health management and policy making is to develop, concerted action is needed by a range of stakeholders including government agencies, health care organizations, research funders, academic centers and professional associations. Firstly, cultural and attitudinal change is needed, which can be brought about through a range of measures aimed at closing the gap between managers and policy makers on the one hand and researchers and academics on the other. Secondly, government agencies and research funders need to invest in developing the infrastructure to support evidence-based decision making." (Rundall, 2002, p.1)
Implications stated by Rundall (2002) for policy, delivery or practice is as follows: "In the long-term, concerted action by key stakeholders in the healthcare system would help to develop a cadre of managers and policy makers with the skills, systems and support needed to use evidence more effectively in their own decision making and to support the development of evidence-based clinical practice. Such developments would be likely to result in improvements in healthcare quality and health system performance." (Rundall, 2002, p.1)
Summary and Conclusion
This work has sought to conduct an assessment of the potential of an evidence-based approach to health care management and through the means of a review of literature in this area of study. The research questions addressed were those of: (1) How does evidence-based management compare with evidence-based medicine? And (2) Could an evidence based approach led to improvements in health care policy and practice or are there too many obstacles to its widespread use? This work has examined the work of Lewis and Latney (2003) who report customer satisfaction to be a "critical element of quality management programs" since customer satisfaction impacts "both business results and the community's image of care quality." (p.2) This work has furthermore review the work of Shortnell, Rundall and Hsu who state that not only the content but the context of patient care is necessary and can only be accomplished through the combination and in an integrated approach that is evidence based in bringing about a reduction in the gap of quality standards and in building more trust for the healthcare system in the United States.
One of the primary challenges faced in today's healthcare industry is the shortage of nursing professionals in the healthcare field and examined in this area was the work of McCluskey and Cusick (2002) who has revealed that evidence-based practice is "a process which involves searching for, appraising, and then using research findings to guide clinical practice (Hamer, 1999 in McCluskey and Cusick, 2002) Evidence-based practice is also stated to be "...about using, rather than doing research." (Taylor, 2000 in: McCluskey and Cusick, 2002). p.2 It is important to understand that clinical effectiveness can only be achieved when the healthcare provision professionals are highly coordinated and integrated in the provision of healthcare to the patient / consumer.
McCluskey and Cusick (2002) report that the process of implementing evidence-based practice involves four specific steps and all of which make a requirement of new learning: (1) formulation of clear clinical questions, preferably from a client's perspective; (2) searching the literature for relevant scientific evidence; (3) critically appraising the evidence; and (4) integrating the findings into practice and teaching. (McCluskey and Cusick, 2003, p.3)
It important to note that according to McClusky and Cusick (2003) there is a fifth and final step which is the process of evaluation in which changes to the professional practice are monitored and reinforcement of the desired behaviors takes place. A primary challenge for managers is the coordination of the continuing skill acquisition and professional development that goes hand-in-hand with evidence-based practice. Toward this end, managers generally use regular performance appraisals and learning contracts." (McCluskey and Cusick, 2003) It is clear that more should be invested in evidence-based management and practice in the provision of healthcare and specifically its nursing professional workforce. This includes training, ongoing education, improvement of the work environment, satisfaction of employees and customers and all of this has been found in this research study to be that which will serve to bring about a growth in positive outcomes for patients in a framework of management through use of evidence-based practice.
Institute of Medicine. Performance Measurement: Accelerating Improvement. Washington DC: National Academy Press; 2006.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press; 2001.
Lewis Patricia S. And Latney, Cynthia (2003) Achieve Best Practice With an Evidence-Based Approach. Critical Care Nurse. Vol. 23. No. 6 December 2003. Online available at: http://ccn.aacnjournals.org/cgi/reprint/23/6/67.pdf
Rundall, K. (2002) Evidence-Based Management in Healthcare: Lessons from Clinical Practice. Academy for Health Services Research and Health Policy. Meeting. Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 20. Manchester Centre for Healthcare…