- •Nurse leaders must build on their knowledge of evidence-based practice to cultivate a broader use of evidence in their management decision-making.
- •There are a variety of strategies that can be accessed to support nurse leaders in reinforcing their competence in accessing, appraising, and applying evidence to their management decision-making.
- •By creating a culture of inquiry that utilizes the best available evidence, nurse leaders can participate in delivering successful outcomes that support the practice environment, organizational success, and health care outcomes.
Evidence-Based Management Decision-Making
- Barends E.
- Rousseau D.M.
- Briiner R.B.
- 1.The asking step is when a question is developed—often in response to an organizational problem. The question is then used to guide a search of evidence. As noted, evidence is acquired from multiple sources. Scientific evidence is the external evidence gathered from a search of the published literature. Organizational evidence may include performance improvement results, quality outcomes, and financial metrics. Stakeholder evidence includes the perspectives of those who will be impacted by the decision. Examples may include employees or patients and families. And last, the leader’s professional experience can be factored into the decision process as well. This is the most variable in terms of reliability depending on depth of the leader’s past experiences.
- With an operational loss in the organization in the first 2 quarters,
- a.Is there an effective means of redeploying staff safely across services while ensuring maintenance of competency to reduce cost?
- b.What other options exist to maintain adequate staffing to manage surge situations?
- c.What are the best practices seen to support and retain staff during this difficult time of complex system change?
- 2.The acquiring phase is the time to gather evidence. A systematic search of the literature begins by identifying search terms and search engines. This stage can be facilitated by a librarian, if available. Organizational data are often routinely provided by the quality and finance departments. Stakeholder evidence can be gathered from employee surveys or patient feedback surveys (Figure 2).
- In this case study, the CNO will begin by systematically gathering whatever internal organizational data are available. Despite the difficulties of the last months, she can evaluate patient outcomes in departments in which redeployments have occurred. She can collaborate with human resources to obtain staff input regarding needs for additional training and concerns for personal safety. Patient and family feedback may be available for review as well as input from other members of the professional health care team. These internal data will provide information to the CNO about what may have worked well and where opportunities for improvement remain. Although external evidence may be sought from literature, the CNO may find that little has been published in recent months regarding her questions. In evaluating external evidence, she knows it is preferable to seek high quality research studies.
- However, much of the current research has focused on epidemiological studies rather than the process of care, required resources, and impact on staff. Still, many sources of expert opinion based on experiences in managing disasters and the current pandemic have been made available through professional nursing organizations such the American Organization of Nurse Leaders and the American Nurses Association.
- 3.The appraisal process requires an analysis of the strength of the evidence. The quality of the published research, organizational data, and stakeholder preferences can all be evaluated using a grading system. Published research is generally considered stronger evidence because most often the evidence has been through a review process. Academic publications use a peer-review process and business publications use an editorial board review process. Leaders should carefully evaluate the journal source. There are many predatory journals publishing articles that have not been through a review process and may be of questionable quality. Although organizational and stakeholder data are not published, they can be considered of sufficient quality to inform organizational decision-making if they are collected using unbiased methods.
- In this case, the CNO evaluates the quality of the internal and external evidence. Although not always the strongest evidence, webinars provided by professional organizations delivered by experienced nurse executives may very well constitute the “best available evidence” to inform the problem. The quality of the internal stakeholder data is also evaluated to provide direction to the CNO.
- 4.Once satisfied that she has sufficient evidence, the CNO will move to the aggregating step. In this step, the evidence from the various sources are synthesized to identify contributing factors to the problem and relevant options for resolving the problem.
- 5.The applying step includes an analysis of the various options identified through the review of the evidence. The CNO might consider using a decision matrix to evaluate each option against a few key criteria. The criteria may include the strength of the evidence, fit with the organization, financial resources, feasibility, cost, and effectiveness or impact.
- 6.Assessing is the final phase of the process. This is the opportunity to evaluate the effectiveness of the selected decision once implemented. Evaluation should include formative, process measures and summative, outcomes measures.
- The CNO should determine indicators of success for the selected plan. The initial stakeholder data may also serve as evaluation criteria throughout the implementation phase. In addition to evaluating the implementation process and outcomes of the decision, the CNO may want to identify measures to monitor for potential unintended consequences of a practice change. For example, staff dissatisfaction and stress may be possible unintended consequences of the decision and should be monitored. Evaluation is clearly a critical step that needs to be planned as carefully as the implementation of the decision.
Developing Evidence-Based Management Competencies
- Barends E.
- Rousseau D.M.
- Briiner R.B.
Creating an Organizational Culture of EBM
How Can EBM Be Relevant to Nurse Leaders?
Return on Investment?
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Note: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors acknowledge no conflicts of interest.