Republished from Department of Veterans Affairs Website
The past 20 years have seen intensive development of new models for organization and management in industry and health care. Many observers believe, however, that popular trends and fads have guided this development more than research on organizations and management practices. Often managers rely on consultants for assistance in making and implementing important strategic decisions, but they do not rigorously challenge the information upon which such recommendations are based.
At the same time, however, there has been a significant shift in the way that health care professionals use evidence from scientific research in clinical practice, and the concept of evidenced-based health care has become part of the language of clinicians, managers, policymakers and researchers. But the leaders and managers of health care organizations, while often strongly encouraging clinicians to adopt evidenced-based practices, have been slow to apply the ideas to their own management.
The Nature of Managerial Decision Making
Managers make fewer but larger decisions than clinicians—and the timeframe for those decisions is usually longer. Major managerial decisions may take weeks, months or even years to be made and implemented, and it can be difficult to discern or describe the decision-making process or to pin down when a decision is actually made. Managerial decisions are also more heterogeneous than clinical decisions, in the sense that they do not usually involve the application of the same body of knowledge to a series of similar but different circumstances, so guidelines of decision support aids are seldom used in managerial decision making. Therefore intuition often plays a part in decisions that would defy any rule-based, procedural analysis.
In addition, decision-making for managers, even within a hierarchical structure and chain of command, is often a team or group activity, whether formal committees or informal groups. Securing the support of others is often a key part of the process. Managerial decisions are also often significantly constrained by organizational or wider system requirements, such as resource availability, pressure in the marketplace, policies and procedures and stakeholders' views and interests.
These factors may act as limitations or may even directly conflict with research findings. Because of the constrained, contested and political nature of many managerial decisions, it may be difficult for managers to apply research evidence even when it is available.
There are a number of significant reasons that managers may not consider research when making policy decisions. In the past, nonprofit organizations have lacked accountability for the costs of growing or discontinuing lines of service, and therefore have had little incentive to investigate best practices. Rather, health systems have focused on operating margins and past budgets. Research is often viewed as producing little or no return on investment. More money tends to be spent on consultants’ strategic recommendations, which may not be backed up by research.
In reality, most healthcare organizations are not large enough to carry out management research. But, in larger systems, management has not used the advantage of system size to gather evidence on best practices. The evidence that does exist is often not shared even within the same system. Again, in fairness to managers, it must be noted that there is little evidence available related to best management practices.
There are some practical problems that suggest that conditions typical of health care organizations may be counterproductive to fostering support for management research. These factors include working conditions that involve a heavy workload and tight deadlines. Without a system in place to cope with heavy workloads, the pressure to meet deadlines restricts the time managers have to consider their decision-making process or to examine research. Attitudes that focus on making speedy decisions can interfere with managers’ acceptance of research. In addition, a belief system reinforced by years of experience that management is an intuitive process will restrict support for management research.
Research evidence is more likely to be used in organizations that have a culture that values and encourages innovation, experimentation, data collection and analysis and the development of critical appraisal skills among managers. Organizations must cultivate what has been called a culture of learning through research.
Source: A Framework for Management Research, Department of Veterans Affairs.