Evidence-Based Practice
A New Approach of Teaching The Practice of Management
Eric Barends, CEBMa – Denise Rousseau, CMUMay 6th, 2014
Mission Today• Teaching Evidence-based practice (in 1 hour)
• Disappointment
• Inspiration
Who are we and what is our mission (today)?
Eric Barends• manager• teacher• director• CEBMa
Denise Rousseau• researcher• teacher• professor• CMU / Heinz / Tepper
Postgraduate Course
Postgraduate Course
Postgraduate Course
Postgraduate Course
Current developments
Education
Access to research databases
Rapid Evidence Assessments
Building a community
Postgraduate Course
CEBMa Database of Evidence Summaries
Online learning modules
Accreditational bodies
Future developments: practice
1. Some background
2. Teaching: learning principles
3. Teaching: curriculum
4. Teaching: examples
5. Your questions
Today
Evidence based management:What is it?
1. Some background
Evidence-based practiceCentral Premise:
Decisions should be based on a combination of critical thinking
and the ‘best available evidence‘.
Evidence?
findings from scientific research, organizational facts & figures, benchmarking, best practices,
professional experience
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All managers base their decisions on ‘evidence’
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But…many managers pay little or no attention to the
quality of the evidence they base their decisions on
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Trust me, 20 years of management experience
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SO ...
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Teach managers how to critically evaluate the
trustworthiness of evidence from multiple sources
and help them find ‘the best available’ evidence
An example
An example
An example
Maslow, A.H. "A Theory of Human Motivation”
An example
An example
Professional experience and
judgment
Organizational data, facts and figures
Stakeholders’ values and concerns
Scientific research findings
AskAcquire
AppraiseAggregate
ApplyAssess
An example
Professional experience and judgment
Maslow, A.H. (1943). "A Theory of Human Motivation," Psychological Review 50(4)
Wahba, M. A., & Bridwell, L. G. (1976). Maslow reconsidered: A review of research on the need hierarchy theory. Organizational Behavior and Human Performance, 15(2)
Scientific research findings
How evidence-based are we (managers)?
“I’ve never thought I need more evidence before making a decision;
I know what needs to be done, we get on with it and we get results.”
1. Incompetent people benefit more from feedback than highly competent people.
2. Task conflict improves work group performance while relational conflict harms it.
3. Encouraging employees to participate in decision making is more effective for improving organizational performance than setting performance goals.
True (likely) or false (not likely)?
How evidence-based are we?
959 (US) + 626 (Dutch) HR professionals 35 statements, based on an extensive body of
evidence true / false / uncertain
HR Professionals' beliefs about effective human resource practices: correspondence between research and practice, (Rynes et al, 2002, Sanders et al 2008)
Outcome: not better than random chance
EBP:Teach managers how to
critically evaluate the trustworthiness of evidence
from multiple sources and help them find ‘the best available’ evidence
2. Teaching EBP:Learning principles
Discuss with your neighbours:
When it comes to teaching,
what are important learning principles?
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Learning principles
1. The brain needs time to get used to new things. Longer periods in between practice sessions lead to a longer overall retention.
2. Training program should include opportunities for practice, linked to real world situations .
3. The human brain seeks comfort in what it knows and is familiar with; addressing / confronting prior knowledge increases understanding (start from where the students are)
Learning principles
4. Higher order thinking only happens when people work on questions / problems / issues themselves.
5. Learning from failure is important for learning. Speculating and predicting before finding the correct answers helps people become adaptive learners / experts.
Teaching EBP =
Small groups
Problem based
Real life cases
EBP starts with a practical question, not with an academic answer
3. Teaching EBP:Curriculum
Limitations of human judgment & common forms of cognitive bias
Retrieving & critically assessing experiential evidence
Retrieving & critically assessing organizational evidence (qualitative & quantitative)
Searching in research databases
Efficiently reading research articles
Critically appraising evidence from research
Weighing and aggregating evidence from multiple sources
Incorporating evidence into the decision making process
Different types of decisions and decision-making processes
Assessing the outcome of decisions made
EBP: Curriculum
Professional experience and
judgment
Organizational data, facts and figures
Stakeholders’ values and concerns
Scientific research findings
AskAcquire
AppraiseAggregate
ApplyAssess
A critical and reflective attitude
Skills to distinguish trustworthy from less trustworthy evidence.
Thinking in terms of probabilities
EBP: outcome
CAT: Critically Appraised Topic
CAT: Critically Appraised Topic
A critically appraised topic (CAT) is a
structured, short (2 – 5 pages max) summary
of evidence on a topic of interest, focused
around a practical problem or question..
CAT: structure
1) Background / context
2) Question (PICOC)
3) Search strategy
4) Results / evidence summary
5) Findings
6) Limitations
7) Recommendation
CAT: 3 hits
1. Small group (2-3), scientific evidence, list of topics
2. Individual, scientific evidence & theory, own topic
3. Individual, evidence from multiple sources, real life question / issue
CAT: examples
Is there a valid and reliable way to measure the productivity of knowledge workers?
To what extent will leadership training improve the effectiveness of leaders (e.g. managers, executives), what are the characteristics of effective leadership training programs?
What research evaluating the effects of 360-degree has been published in peer-reviewed scholarly journals in the past 10 years? Which of the variables that are expected to have an impact on the effectiveness of 360-degree feedback are most widely studied and what is known of their effect?
CAT-walk
4. Teaching EBP:Examples
Critical attitude
ASK
Critically appraisal: research findings
Organizational evidence
4. Teaching EBP: examples
Critical attitude ASK
Critically appraisal: research findings
Organizational evidence
4. Teaching EBP: examples
Discuss with your neighbours:What are the most common cognitive
biases in management?
(give an example)
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We are predisposed to selectively search for or interpret information in ways that confirms our existing beliefs, expectations and assumptions, and ignore information to the contrary.
In other words, we “see what we want to see”
Confirmation bias
The amount of information increases faster than our ability to process it.
Increase of information
McKinsey (1997 / 2001)
Case study / best practice
War on Talent
1. Pattern recognition
2. Confirmation-bias
3. Small numbers fallacy
4. Outcome bias
5. Halo effect
6. Authority-bias
7. Groupthink
8. Availability bias
Biases
Assignment
One of your best friends is trader on the stock exchange. He enthusiastically tells you he has analyzed a large number of financial and economic data and that he has discovered an interesting phenomenon: "The position of the Dow Jones index multiplied by the price of oil is two days ahead of the gold price!" In other words, if both the Dow Jones and the oil price go up, the price of gold will rise within a day.
Bias? Critical questions?
We are predisposed to see order, pattern and causal relations in the world.
Patternicity: The tendency to find meaningful patterns in both meaningful and meaningless noise.
Bias: pattern recognition
Assignment
Most people will prefer doctor B
Why? Bias? Critical questions?
doctor A doctor B
Last operation: patient died on the
operating table
Last operation: patient recovered
faster than expected
Outcome bias
We are inclined to evaluate the quality of a decision (intervention, method) on the basis of its outcome.
Bias: Outcome bias
The Asch Experiment
Nasa, Challenger
Groupthink:
Groupthink is a psychological phenomenon that occurs within a group of people, in which the desire for harmony or conformity in the group results in an incorrect or irrational decision
Bias: Groupthink
Bounded rationality
System 1 Fast Intuitive, associative heuristics & biases
System 2
Slow (lazy) Deliberate, ‘reasoning’ Rational
Bounded rationality
limbic system and brainstem(system 1)
neo cortex(system 2)
Critical attitude
ASK
Critically appraisal: research findings
Organizational evidence
Teaching EBP: examples
Postgraduate Course
Postgraduate Course
1. Problem identification
2. Surfacing assumptions
3. Logic model
4. Formulating a searchable question
5. Formulate sub-questions
5 steps
Postgraduate Course
For which problem is ….. the solution?
For who(m)
Why
How big ?
How do we know (what is the evidence?)
Step 1: What is the problem?
Postgraduate Course
“Door to needle time”, 48 UK hospitals in Westmidland
Our hospital
The problem
Postgraduate Course
Discuss with your neighbours possible causes for these
differences that could not be solved by the implementation of
Lean / Six Sigma
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Postgraduate Course
1. Problem identification
2. Surfacing assumptions
3. Logic model
4. Formulating a searchable question
5. Formulate sub-questions
5 steps
Postgraduate Course
Logic model
Postgraduate Course
A logic model spells out the process by which a problem or intervention is expected to produce certain outcomes.
In making expectations (its logic) explicit, a logic model helps identify the kind of evidence needed.
Logic model
Critical attitude
ASK
Critically appraisal: research findings Organizational evidence
4. Teaching EBP: examples
Critical appraisal
Always start with a practical question:- does it work?- how many employees …?- how do employees feel about …?
How could we find out?
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Critical appraisal
Amanda Burls:
“I never tell them anything about randomization or blinding, I just ask: “How are you going to know? How would you test this if I would give you a half million dollars to test it?” And when they come up with a suggestion I say, “Alright, can you think of any reason you got the results showing it works, while in fact it doesn’t.” And they say, “Well, it could be this, it could be that” And then I say, “Ok, then redesign your study so it can’t be this,” and what they come up with are precisely those things: randomization and blinding.”
How trustworthy is this study?
Two studies, different designs
Studies with methodological flaws
Best available evidence (so what now?)
Online course!
Critical appraisal
Critical attitude
ASK
Critically appraisal: research findings
Organizational evidence
4. Teaching EBP: examples
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Organizational facts and figures
Organizational facts and figures
Organizational facts and figures
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Organizational facts and figures
Organizational facts and figures
Examples
1. Added value
2. Types of organizational evidence
3. Starting point: logic model
4. Statistical aspects to consider
5. Barriers to overcome
Organizational evidence
5. Barriers to overcome
1. Small numbers problem
2. Measurement errors
3. Context
4. Tainted data
5. Politics