Evidence-Based Management, Part II John Zanardelli, MPH, FACHE Executive Director and CEO United Methodist Services for the Aging; Adjunct Associate Professor Graduate School of Public Health, University of Pittsburgh

Knowing about and understanding evidence based management (EBM) and actually applying EBM in addressing organizational challenges are two entirely different things. One relates to understanding and knowledge; the other relates to knowledge that is applied. Without application, nothing much happens.

So, how can an organizational leader transform a culture to one that embraces and uses evidence in its management practice? The following are some concrete examples from the organization in which I work, United Methodist Services for the Aging.

(1) Provide an overarching framework through which the concept of EBM can be understood. I use the framework of a “logic model” to help managers see how evidence works in practice -- going from inputs, through process, to outputs, to outcomes, to quality outcomes, and ultimately effect. I ask “What theory are you going to use to enhance your chances that your process will lead to the desired quality outcomes, and hopefully to have a positive effect?” Managers generally see that when they are trying to use their inputs (staff, residents/customers, equipment, supplies, etc.) and then applying some process to get some desired outcome, they are operating on some “theory of change,” even if it isn’t explicitly stated. We then talk about how explicit change theories, those based upon good evidence and not anecdotes, increase the likelihood that the desired end result will occur.

(2) Find opportunities to resolve organizational challenges using empirically derived evidence. Several recent examples include Laurie Weingart and Matt Cronin’s “Theory of Representational Gaps.” Getting a manger to work together to solve organizational problems can be a challenge when it’s “every man for himself,” sometimes referred to as a “silo mentality.” I invited Drs. Weingart and Cronin to provide a training session for our managers on “representational gaps;” first demonstrating how fifty percent of what we “see” is behind our eyes, and how both liking and understanding play into working collectively toward a common goal (interest based negotiation). The “intervention” that we used to address these lapses in understanding of the other’s perspective was shadowing. Managers who were highly interdependent were paired to shadow each other in order to get a better perspective of the other’s viewpoint. A validated and reliable measurement scale was applied at baseline. After the intervention was implemented, another measurement was taken to see if there was a positive change – which there was. Probably equally beneficial was introducing the concept of differences in perspectives and schemas; each “seeing” their viewpoint from the beholder’s eyes.

Another example is related to organizational change and the disruption it can have on employees. Change is a way of life in the modern organization; however, transitions can be difficult and disruptive. Through my association with my colleague at Carnegie Mellon University, Professor Denise Rousseau, I had learned of her theory of “psychological contracts” and an empirically derived framework whereby change can be made in a fashion that reduces its negative aspects. Specific application included involving first line employees early on in the change process, encourage trusting by explaining to them why the change was necessary, soliciting and, when possible, using their ideas to make the change more palatable, and creating bridging mechanisms to lessen any burden that they might incur as a result of the change. By following this empirically validated “framework of change,” we engendered trust among our employees; they had voice in the process; and the change was less disruptive as a consequence.

(3) Find ways to relate EBM to other uses of evidence in organizational operations. Our organization is a provider of healthcare. Medicine and public health appear to me to be ahead of management in their use of scientifically derived evidence. By finding ways to relate what we are doing clinically and programmatically with the use of evidence, clinicians who are also managers, begin to see exactly what EBM means. We are currently involved in an evaluation of our exercise program (“Seniorcize”) as it relates to falls prevention. The “theory” that the exercise program operates on is that by improving strength, flexibility and balance, it will then lessen the likelihood of a fall in an older adult. I can highlight that our program operates on a theory that has been proven, scientifically, can work (efficacy). I then relate that back to the theory, or lack of one, that our management actions are premised upon. Analogies can prove enlightening.

My plan is to constantly communicate what evidence is, how it is used to translate inputs and process to desired results and use every opportunity I can to apply evidence to organizational efforts by our managers. Over time my working hypothesis is that our culture will become one of basing actions, management and otherwise, on empirically derived evidence.

Posted on October 18, 2006

>> Read Evidence-Based Management (Part I) by John Zanardelli


 

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