Evidence-Based Leadership Analysis

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Evidence-Based Leadership Analysis
Capella University
Amanda Nagle-Chicoine

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Abstract
The evidence-based practice movement was first founded by Dr. Archie Cochrane. In 1972 he
published a landmark book that criticized the medical profession for not providing rigorous reviews of
evidence in order for policy makers and organizations to make the best decisions regarding healthcare. As a
result of his efforts the Cochrane Center was launched in England and The Cochrane Collaberation was
founded a year later. Although the clinical side of EBM has come a long way, healthcare organizations have a
long way to go for Evidence-Based Management and Leadership to become a reality.

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Introduction
In order for healthcare to be safe and effective as well as efficient and reliable, leaders and
researchers in the healthcare industry have begun to understand the concept of correct clinical decisions
relying on the application of evidence-based medicine. Recently, it has become increasingly obvious that
“successful implementation of evidence-based medicine requires the support of evidence-based
management (Fraser & Clancy, 2009, p. XY). In other words, “healthcare can only be as good as the system
that provides it” (Fraser & Clancy, 2009, p. XV).
The purpose of this paper is to analyze evidence-based management and leadership. In
order to perform a thorough analysis, a literature review on the history of evidence-based
management was performed, including a comparison of the practice of EBML in healthcare and
non-healthcare professions. The paper also identifies a healthcare leader and their use of
EBML.
An analysis of EBML would not be complete without a discussion of the strengths,
weaknesses, opportunities and threats (SWOT analysis) associated with the practice of
evidence-based management. A SWOT analysis is used in most professions or industries
because it shows the pros and con in a simplified format.
Finally, the following null hypothesis is given:
“There is no evidence to suggest there is resistance to the adoption of EBML among
healthcare leaders and managers” Ho (Unit 10, p.1). The question remains whether to accept
or reject the hypothesis. When one considers the amount of literature available on this topic,
the decision might be rather surprising.

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Literature Review
History
The Oath of Maimonides (after the twelfth century physician and philosopher Moses
Maimonides) says “”Grant me the strength, time and opportunity always to correct what I have
acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend itself
indefinitely to enrich itself daily with new requirements” (translated by Friedenwald 1917) (Goodman,
2002, p. 1). Goodman brings up a valid point that the physician could only be referring to keeping up
with the ever-changing medical field. He is also right that it is a moral issue when a patient is harmed
because of a physician’s lack of knowledge if another physician has taken the time to stay informed and
could have helped the patient.
In 1834, Pierre Louis published his Essay on Clinical Instruction. This was the first of several
essays Louis published during this period. He is also known for performing the first chart reviews
(“outcomes research”) and is therefore the reason this period is known as a corner-stone in the history
of clinical evaluation (Porter, 1996).
It wasn’t until the middle of the twentieth century that medical science evolved and the tool
known as randomized clinical trials which is regarded as “the golden standard for generating the
necessary information that we can then turn into evidence” (Goodman, 2002, p. 6). The problem then
became there was no system in place for clinicians to find what was needed in a vast and sometimes
contradictory pile of information.
It was Archie Cochrane who said “It is surely a great criticism of our profession that we have not
organized a critical summary, by specialty or subspecialty, adapted periodically, of all randomized
controlled trials” (Cochrane 1979; cf. Cochrane1972) (Goodman, 2002, p.7). Cochrane is known to have
done as much as any other individual to reshape health education and the practice of medicine.

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Definitions and Theory
According to Sackett (1996) EBP is “the conscientious, explicit and judicious use of current best
evidence in making decisions about the care of the individual patient. It means integrating individual clinical
expertise with the best available external clinical evidence from systemic research”. Rousseau (2006) refers
to the integration of the best available evidence with decision maker expertise along with client preferences
to produce more desirable results (Kovner, Fine, & D'Aquila, 2009, p. xxi).
The Transformational Theory of Leadership plays an important role for organizations adopting
evidence-based decision-making. Transformational Leadership encourages employees to voice their opinions
(which naturally leads to the discovery of hidden talents and knowledge) and employees are in turn less likely
to leave the organization. On the contrary, if employees view their managers as mentors, they are much
more likely to perform at a higher standard and develop their own leadership skills (Thompson, 2012).
Several authors directly link Transformational Leadership and EBML (Studer, 2009), (Kenney, 2012), (Kouzes
& Pozner, 2007), (Ingersoll, Witzel, Berry, & Qualls, 2010), (Gawunde, 2009) (Rousseau, 2006), (Klimoski &
Amos, 2012) Note: These are the ones at first glance- but it is definitely not meant to be an all-inclusive list.
The amount of literature available in Evidence-Based Management and Leadership (EBML) as a
whole is extensive. Despite the overwhelming amount of articles and texts available, certain authors stood
out for their contributions to the literature. These authors were either cited frequently for one particular
article or in many cases the same authors had numerous articles published on the use of EBML. To name a
few: Kovner: Besides the text, he has written numerous articles for ACHE journals such as Frontiers and The
Journal of Health Administration, another book entitled Health Services Management: Readings, Cases and
Commentary (Kovner & Neuhauser, 2004), Healthcare Delivery in the United States (Kovner & Knickman,
2008). Rundall: Frontiers (March, 2006), Journal of Healthcare Management (May, 2007), The Journal of the
American Medical Association (June, 2006), The Millbank Quarterly (March, 2001), etc. It appears certain

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authors have written too many to name- yet there are still a few names very worthy of mentioning such as
Pfiffer, Sutton, Rousseau, and Sackett.
Ingersoll, Witzel, Berry, and Qualls (2010) and their article on EBML in Hospital-Based Nursing
Reseach Centers is important because their research points out the need for more nursing research centers.
Despite the fact that hospitals applying for Magnet designation or redesignation need to show an increased
focus on growth and expansion in research and EBP activities, few descriptions of this type were found. The
existance of these centers should be a top priority among hospitals because it is this type of organization that
“can create the structures and processes needed to promote and sustain EDP and assist in the monitoring of
care delivery outcomes” (p.227).
Health Services Research
Funded by the National Library of Medicine, public health systems and services research (PHSSR) is
“a field of study that examines the organization, financing and delivery of public health services in
communities, and the impact of these services on public health” (Public Health Systems and Services
Research Overview, 2011). In the past a great deal of research related to the practice of public health was
constantly focused on the multitude of governmental agencies that dealt with guarding and promoting
community health. PHSSR includes not only all governmental health agencies but private and nonprofit
agencies as well. In this way researchers wishing to focus on communities will be in a position to get a full
picture of a particular community’s issues and services devoted to those issues as well.
When The Institute of Medicine published The Future of Public Health in 1988, both agencies and
academia were called on to examine the public health system from varying perspectives. The result was to
begin the process to improve the health of both individual citizens and communities as a whole.

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Comparison of EBML in Healthcare and Other
Industries
Other Industries
Long before Doctors had figured out that they should be practicing Evidence-Based medicine, other
industries wouldn’t consider making a major decision without first weighing all the pros and cons. For
example in Finance, if a company wants to make a large purchase they must first run all the ratios and
consult different vendors to determine the best price. The following are examples of how different industries
use Evidence-Based Management:
• More goes into marketing a product than one might think. Since marketing is attempting to
influence the behavior of others, a large amount of research is done such as surveys and
researching current trends. Advice and strategy should only come from experts in the field in
order to put together the best campaign possible (Martin, n.d.).
• Warren Buffett, known as one of the most successful financiers in history, takes his time
when studying a company. Sometimes the process takes weeks, but he researches
everything there is to know about the company he is considering buying. When it is time to
make the deal, Buffet, who has an I.Q. of 300 or so makes a ‘mental’ checklist so he is sure
nothing will be overlooked (Gawunde, 2009).
• The state of Washington has decided the only way to keep from building new prisons is to
get to the at-risk youth before they become criminals. Evidence-Based Associates is a non-
profit organization who work with troubled youth and use nothing but evidence-based
programs. These programs have changed the lives of many young people- which of course
affects the entire family in a positive way. If this plan succeeds it will also save the taxpayers
$2 Billion in taxes (Amos, Miller, & Drake, 2006).
• In the field of Industry Organizational Psychology, Briner and Rosseau (2011) gave four
sources of information and evidence as the basis for EBM: 1) Practitioner expertise and

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judgement 2) Critical Evaluation of best evidence and research 3) Evidence from the local
context 4) Perspectives of those who may be affected by an intervention decision. Briner
and Rosseau’s article showed in two separate searches- the second was in a presentation by
(Barrett, 2011) and theirs was the target article on EBML in the I/O field.
Several commentaries followed their article. For example, Cronin and Klimoski (2011) do not
completely agree with Briner and Rosseau (2011) because their article “sees practioners as buyers in a
market where academics are sellers”(p.57). Cronin and Klimoski (2011) instead see evidence-based practice
as a supply chain and represent this chain involving four groups: The first group is the Manufacturer (Basic
Researchers). The next group is the Supplier (Applied Researchers). The third group is the Producers
(Practitioners such as MBA’s and HR whose knowledge, skills, and abilities are at the managerial level. The
final group, or End User, are the stakeholders. This group could include anyone from employees and
shareholders to C-level executives. Therefore their knowledge, skills, and abilities will vary (p.58).
Education and EBML
Although EBML is used in many industries, it would only make sense for universities to teach
students in MBA programs how to use research and best practices to help students develop into effective
leaders. Klimoski and Amos (2012) point out the irony in the fact that university faculty are in the best
position possible to apply the findings from this method of research yet this does not appear to be
happening.
It has been established previously that the Transformational Leadership theory is thought to be the
most prevalent for fostering a culture among leaders and those aspiring to develop the skills needed for the
development of leadership (Kouzes & Pozner, 2007). According to Klimoski and Amos (2012) the problem of
transforming students into leaders has more to do with the time constraint imposed in a typical MBA
program. They also make the point that while students are expexcted to be engaged in developing these
leadership attributes, they are also expected to master advanced knowledge in a variety of subjects. They go
even further by pointing out what many professors do not take into consideration: For many students getting

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advanced degrees there are other demands placed on students (i.e. work, family and community) (p.689).
“Clearly there is need to consider how curriculum experiences and field work (e.g., internships) should be
woven into the pattern and practice…” “In short, as befits all types of transformational learning, leader
development requires a kind of “co-reproduction” between theory and practice, book learning and skills
building” (Klimoski & Amos, 2012, p. 693)
The Healthcare Industry
According to Fraser and Clancy (2009) the widespread use of evidence-based management will come
about slowly in the healthcare industry. Healthcare is much different from any other industry. “To act on
evidence, however, managers need information at a much more grandular and actionable level-what kind of
system change, with what kind of implementation strategy is likely to reduce which kind of error?” (Fraser &
Clancy, 2009, p. xvi).
Although EBML is used in other industries, naturally EBML in healthcare would be much different. In
many other industries, the most important thing is ‘the bottom line’, or numbers. In healthcare, the most
important thing is the patient. This certainly doesn’t mean healthcare isn’t concerned with efficiency
and cost because in order to bring good, quality health care to as many people as possible,
healthcare must consider cost and efficiency as well. Still healthcare’s use of EBML would be
different from any other industry because the single most important thing to consider is ‘What is best
for the patient’?
Should the Adoption of EBML in Healthcare Continue?
“It is now widely recognized throughout the globe that evidence-based practice is key to
delivering the highest quality of healthcare and ensuring the best patient outcomes” (Melnyk & Fineout-
Overholt, 2005 Chp 1). Despite this statement, the key findings of Kovner, Fine, and D'Aquila (2009)
made two major points regarding the use of EBML:

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1) Decision-makers report using research evidence rarely; instead, they rely on
recommendations from external organizations, personal experience, and the experiences
of peers and consultants.
2) Decision makers perceive that the content and accessibility of existing research are
inadequate. (p.13)
This, however, is given as a main reason for Kovner, Fine, and D’Aquila writing the book. They
were each interviewed at the end of the book and each felt that a main reason for many hospitals’ poor
performance is that decisions are not based on a review of the evidence (Fine, p. 249). Kovner stated
that many healthcare CEO’s believed that management research should be conducted by universities,
foundations, and government (p.250).
According to Rosseau (2006), evidence-based practice has tremendous substance and discipline
behind it. Two examples where impact has been strong are police officers and secondary education. For
example, in secondary education many schools allow students who have difficulty passing their courses are
eventually sent to the next grade anyway. Research has shown that ‘social promotion’ benefits outweigh the
disadvantages because an individual with a high school diploma is much more likely to find a job. This in cuts
down on drug use and crime.
It is obvious EBML can be achieved. Virginia Mason Medical Center, Intermountain Healthcare,
Cleveland Clinic, as well as Lee’s own organization, Partners Health Care, have achieved remarkable results
through the use of Evidence-Based Management (Lee, HBR, 2011). Lee also tells a brief story of an older
woman whose husband was dying of cancer. In the last few days before his death, she stated quite firmly
that she wanted all his doctors to have a meeting with the family. The reason for this was because she
pointed out that various physicians were giving conflicting information and she wanted to be sure they
actually communicated with each other. According to Lee (2011) this is exactly why a new kind of leader is
desperately needed (one that insists on EBML, can organize doctors, improve certain processes and most of
all get rid of all the dysfunction that takes place).
Gawande (2009) has spent years in his determination to fix healthcare. He is the author of several
interesting books and Morse (2011) interviewed him for the Harvard Business Review. Gawande is well

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known for his insistence on ‘checklists’ in all phases of healthcare. In Harvard Business Review he is asked the
following question: “Despite doctors’ resistance to new ideas, surgical checklists are gaining a foothold. What
does that tell us about how to speed up other changes in healthcare?” (Morse, 2011) Gawande explained the
importance of getting everyone involved to understand the reasoning behind a particular practice- in other
words have them “embrace” it. He further explains it should be quick to use as well as easy and “adaptable to
a variety of settings, and of obvious benefit” (Chp. 2). These checklists have proven their worth by clinicians
as well as hospitals. The result has been saved lives and has also shown how efficient things become – this
causes teamwork and that is of course another important part of good healthcare.
This section is being written in St. Vincent’s Hospital in the Intensive Care Unit. St. Vincent’s is a part
of the Tenet Health System. Naturally it was impossible to be there and not watch how things were done.
Two nurses were interviewed and they both said yes, the hospital did indeed practice EBML. There were
three noticeable areas where this hospital seemed to be above and beyond any other hospital in the
Birmingham area. The first thing noticed was the nurses all seemed to feel empowered to do what they
needed to do for the patient as well as the designated family member who was allowed to stay with the
patient around the clock. It was clear they were familiar with Transformational Leadership and therefore they
made sure the patient never had to wait for meds or constantly ask for the authority before acting. They
interacted with the patient’s ‘support person’ and encouraged them to feel free to stay in the room when the
patient was sleeping or told them they could go in one of the many waiting rooms or chapel. They said if the
patient woke and asked, then they would immediately call. The place was so big there were staff who would
get you back to the patient’s room if you got lost- it was as if it were a pleasure to be helping in any way they
could (if they had something more important to do one would never have known it).
“We strive to provide care that is evidence-based, scientifically sound and reflects the best
information available. The integration of evidence-based practices into the care we provide is reflected in our
performance on key quality indicators, known as “core measures” by the Centers for Medicare and Medicaid
Services (Corporate Sustainability Report, 2011).

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Two other areas in which this hospital was exceptional was in the constant reminders for staff,
patients, and visitors to use germ fighting “hand wipes” that were located everywhere one looked. Obviously
they took the spread of infection very seriously. The third area was the beautiful design of this hospital with
all the large open spaces, and all the glass and water-falls.
Evidence-Based Design is being used by hospitals in an effort to provide better patient outcomes as
well as improve the morale of their staff (Burt & McAlearney, 2013). One goal is to create environments
where hospitals are bright from exposure to sunlight which is known to promote healing as well as reduce
medication errors. Other goals include lowering rates of acquired infection (alcohol hand dispensers along
with signs posted in patients rooms and even outside physician practices in the professional buildings,
waiting rooms, etc.), and well -designed patient rooms to reduce noise levels and patient falls. Other features
include acuity-adaptable rooms which dramatically reduces patients being left unmonitored in hallways and
decentralized nurses stations reduces wasted time nurses spend walking down long corridors to patient’s
rooms and frees them to provide more time spent with the patient (p.222).
Leader in the Healthcare Industry and Their Use of
EBML
Choosing just one leader in the healthcare industry was tough. There are quite a few bright and
shining stars to choose from. Quint Studer of The Studer Group is a personal favorite. While working on my
MBA every healthcare course had him on ‘The Muse’ as one of the chosen websites to visit and after reading
Hardwiring Excellence plus downloading all the articles available on the web site Quint Studer definitely had a
fan. “Results That Last” (Studer, 2008) explains the concept of true leadership in an organization. He explains
it is not the products, services, or even wonderful employees- people change jobs all the time. That is not
what creates results. According to Studer it is consistency: excellent leadership from the head of the
organization, from leader to leader, and consistent great employees from one department to the next.

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Studer explains the above process in detail. First, the organization must implement an objective
evaluation system that lets leaders know what they ought to be doing and also which of these are top
priorities. Next, the organization must agree to implement at the leadership level. This is done to ensure that
each employee gets a consistent experience.

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The strategies that bring this about are the kind used by the Studer Group. They are based on
outcomes that have been tested and re-tested first by Studer and then by the large number of organizations
who hire the company to help them improve their own leaders’. Studer (2009) uses the following as goals all
organizations should strive to achieve:
1. Organizations should have an objective and measurable leadership evaluation that
effectively holds people accountable for results.
2. Leaders must get the training they need to ensure they have the skill sets the organization
needs to respond to the external environment.
3. Leaders should have a set habit of visiting or ‘rounding’ with employees.
4. Leaders should use best practices to recruit and retain employees.
5. Leaders should consistently recruit high performers, develop middle performers, and de-
select low performers.
6. Leaders should write thank-you notes to employees doing exceptional work and ‘manage-up’
other leaders and performers.
7. All employees should be trained in ‘communication best practices’ that help reduce a
patient’s anxiety, de-fuse frustration, and ensure understanding.
8. Communication to employees should be standardized, cascaded and transparent so that
everyone understands the urgency of the external environment and how they can help the
organization best respond. (pgs. 54-59)

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SWOT Analysis for EBML
Strengths
• Helps support the patient care process (What is Evidence-Based Practice?, 2010)
• Healthcare is safe, effective, efficient, and reliable (Kovner, Fine, & D'Aquila, 2009)
• Well-defined, evidence-based and promulgated by AHRQ can be replicated across
healthcare organizations and therefore lead to a patient’s sense of well-being (Govenor's,
2008)
• The use of EBMA leads to lower costs and makes healthcare more accessible. Example: A
cost-benefit analysis of electronic medical records in primary care was performed. The data
obtained was from published data and Partner’s Health Care System- along with a seven
member expert panel (Wang, et al., 2003). The panel constructed a hypothetical primary
care provider panel using average statistics along with data from 2,500 anonymous patients.
Although the first year incurred a loss, everything after the initial investment resulted in the
following benefits: cost savings from ‘chart pulls’, transcription fees, adverse drug events
were minimal, and billing errors would be reduced immediately due to automatic prompting
in required fields. To summarize:
 The net benefit of implementation was $85,000 per provider
 Improved quality of care
 Reduced medical errors
 Access to information increased dramatically
(Wang, et al., 2003)
• According to Pfeffer and Sutton (2006), the one thing that is broader and more important
than any single guideline for reaping the benefits of EBML: “Cultivating the right balance of

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humility and decisiveness is a huge goal, but one tactic that serves is to support the
continuing professional education of managers with a commitment equal to that in other
professions” (p.73).
Weaknesses
• According to Kovner and Rundall (2006), time restraints pose a significant problem in many
cases when a decision is needed and there is no time for research.
• There is an over-abundance of ‘evidence’. Some of it has been rigorously tested, yet there
are many articles and information that might be published but that alone does not make it
credible.
• Black and Gregersen (2009), in their book on leadership and change management point out
an important fact that leaders who are trying to move their employees toward an evidence-
based style of management would do well to remember: Once the majority of employees
begin to understand and see the concept behind evidence-based management does not
mean the battle is won. There are two more very important steps that still must be taken.
What if several key employees see and understand the need for this change but have a hard
time actually making the transition? Is this becomes a reality then nothing has actually been
accomplished (in other words, a sort of paralysis has set in.
If this is the case, there are specific tools for accomplishing this- (for example, clear and
concrete target behaviors are given). This must be followed by a tool which maps out
required resources (Black & Gregersen, 2009, p. 76).
• Another weakness in EBML is that seeing the need for change and even providing resources
still does not guarantee evidence-based management. Failure to finish happens quite
frequently (Black & Gregersen, 2009, p. 88) because due to the lack of positive
reenforcement employees get tired and lost and at this point they have not been given

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encouraging feedback from their immediate supervisor and they begin to lose faith and
revert to their previous way of doing things.
Opportunities
• Exceptional leadership is present and if this is the case then all employees are receiving
organization-level measurement and communication in the form of dashboard
measurements. It is this high level of communication (or as Studer (2009) calls it ‘rounding’
that pushes employees across the finish line so that EBML becomes the norm.
• It is a well-known fact that effective leaders are able to influence others by creating a vision
of exactly what can be accomplished. This type of leader has effective interpersonal skills
that inspire, motivate, and empower staff.
• Computer simulation has been successfully used to provide learners an opportunity to
develop leadership skills by giving them a safe environment to engage others and perfect
their communication skills. “Simulation is defined as the attempt to replicate the aspects of
a clinical situation or process so that the experience is comparable to the real work
environment” (Radovich, et al., 2011, p. 59).
• According to Hoffman (2010), the development and application of evidence-based
management practices can have a comparable benefit for patients, staff, healthcare
organizations and the communities in which these practices are used- especially when
economic resources are insufficient to acquire new technology and additional staff but it
must be treated as an ethical issue so that these practices will be recognized and adopted
• In a professional policy statement, the Board of Governor’s of the American College of
Healthcare Executives published the following:
“ACHE believes healthcare executives should lead a comprehensive approach to ensuring
patient safety and quality, including…Rigorously seeking out and applying best practices.
Well defined, evidence-based practices such as those promulgated by the AHRQ, are

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replicable across healthcare organizations and have been shown to lead to improved
outcomes. The use of such established best practices should be a key component of an
organization’s patient safety/quality strategy” (Govenor's, 2008)
• The National Leadership Council has introduced self-assessment tools and frameworks to
support all staff levels in developing self-awareness and teamworking skills as well as
service-improvement strategies at the organizational level. According to Thompson (2012),
this approach centers on the relationship between leaders and staff and therefore builds on
the transformational leadership theory (Kouzes & Pozner, 2007).
Threats
• There has been a poor uptake of management practices of known effectiveness. “The result
is a research-practice gap…” (Rousseau, 2006, p. 256).
• Economic challenges pose a threat for staffing problems which can mean the wrong skill-mix
– making it harder to acquire evidence-based best practices (Thompson, 2012)
• Business educators at the MBA level are not making use of what research has shown is the
best knowledge for building leadership skills- or in other words, education is “not engaged in
evidence-based teaching” (Klimoski & Amos, 2012, p. 685).
• “Management decisions, initiatives, and programs should be grounded in a process whereby
managers ask the right questions and assemble the right information for the decision”…it is
not being universally practiced with the result that managers make many faulty decisions”
(D’Aquila, 2009 p.249).
• “Implementing EB management requires a culture shift in organizations that many managers
are not willing to lead” (Kovner, 2009 p. 250).

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Hypothesis
The following null hypothesis: “There is no evidence to suggest there is resistance to the adoption of
EBML among health care leaders and managers” is rejected. Although there is certainly plenty of information
on EBML, there were very few articles that chose to completely ignore the fact that healthcare leaders are
not doing a great deal of evidence-based decision-making.
The very first chapter of the text told about a study conducted by a group of researchers known for
their research and publications in the Evidence-Based Management field. In the first sentence it states:
”Using research evidence when making decisions about the organization, financing, and delivery of healthcare
has great appeal, yet research suggests that health services managers routinely do not consider it” (Rundall,
et al., 2009, p. 3). The group of researchers put together four focus groups made up of 32 senior decision
makers from all over the United States. Although several people were familiar with evidence-based medicine,
it was noted that very few of the participants were familiar with evidence-based management or
policymaking. Most shocking were the comments made by the participants because what they referred to as
evidence included personal experiences, recommendations from vendors, and policies and regulations
pertaining to a decision (p.8).
The focus group came up with quite a long list of what they perceived as barriers to the use of EBML.
The one cited most frequently by the group was organizational culture. Others that were high on the list
included inadequate resources, an over-all lack of knowledge regarding EBML, decision making restrictions
due to HR policies and regulations, laws and political as well as institutional pressures.
There was another barrier which brings into question most healthcare organizations in this country.
Granted there are some excellent, highly reputable organizations in the United States and after reading

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about some of them (i.e. Virginia Mason), it is hard not to pick up the phone and beg them to allow a certain
someone from Birmingham, AL to work for them- even as a volunteer!
However, as far as other organizations in this country- it is actually scary when one thinks about it:
This research study used 32 senior decision makers from 26 public and private organizations across the
country. Another major barrier they cited was “weak leadership support” (p.11). The only way any
organization is going to do anything is for the “Senior Decision- makers” to make some decisions such as
getting rid of the weak leaders (or possibly step down themselves), set certain goals (EBML would be a good
place to start). They need to carefully plan a strategy and it appears the first step would be to find a coach,
consultant, or trainer who specializes in EBML and have several training sessions. Once everyone who needs
to understands EBML then steps can be taken to implement the use of research and work on best practices
throughout the organization.
How is it possible that out of 32 random but senior decision makers, only one participant stated
that their organization used an evidence-based approach? One other question: Is it really possible that “of 88
total mentions of sources of evidence, only one participant mentioned print journals as a source of evidence”
(p.10)?
The above few paragraphs were written more from shock but after checking the evidence for
strategies to advance the use of EBML, there were several suggestions. Health services researchers should be
trained so that they can not only conduct the research but communicate the evidence in a way that allows
health services managers and policy makers to understand and use all that is available. According to Rundall,
et al. (2009) research evidence must be useful and contain the four A’s: accuracy, applicability, actionability,
and accessibility (p.14). If this were the case, it would most likely be used most of the time.
Conclusion
McVey, Fazzino, and Palmucci (2013), gave one example after another of ways in which the correct
use of research and applying the evidence had saved hospitals millions of dollars. They also made an
excellent point about the National Institute of Standards and Technology setting standards for all industries

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except healthcare. EBML is explained as a way of seeing things differently and using better, deeper logic so
that managers are able to run their departments more efficiently. There is no bias involved- it is simply
reading, writing, and math which provide the evidence. It does require enhanced competencies and
healthcare managers need learning tools. Pfeffer snd Sutton (2006), talk about turning EBM from a practice
of a few to the mainstream. EBML makes more sense because it does deal with numbers- Numbers are
strictly black and white with no gray area for misunderstanding. They also suggest a great way to propel
EBML to the mainstream is for every known healthcare manager who uses EBML to begin networking and get
credible people to advertise its value. If this is done, EBML could actually change the direction of healthcare
in this country.

EBML ANALYSIS 22
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