Use this URL to cite or link to this record in EThOS:
Title: Exploring evidence based management in the National Health Service : if doctors in the NHS use evidence based medicine, why don't managers in the NHS use evidence based healthcare management? : can this paradox be explained and is the paradox true?
Author: Sharp, D.
Awarding Body: Nottingham Trent University
Current Institution: Nottingham Trent University
Date of Award: 2010
Availability of Full Text:
Access from EThOS:
Access from Institution:
Purpose and aims of the study: To contribute to the on-going debate over whether the use of evidence could and should improve organisational effectiveness. This is especially important in the context of the health service that has, since (May 1997) enthusiastically adopted evidence based medicine as its method of health delivery. To develop a practical explanation for policy makers and managers on how and where evidence based management is used appropriately. Justification: Kovner and Rundall (2006 p3) said “the sense of urgency associated with improving the quality of medical care does not exist with respect to improving the quality of management decision making. A more evidence based approach would improve the competence of the decision makers and their motivation to use more scientific methods when making a decision”. The paper reviews the conclusion of Kovner and Rundall (2006) (an American study) within the context of the UK National Health Service. There is a need to develop a theoretical framework of how and why evidence is (or is not) used by managers in the NHS. Motivation: The author holds a senior management position in the National Health Service. The author has performed the role of Director and Chief Executive in NHS organisations since 2000. These organisations have been surplus making, target hitting, award winning, credited by the auditors and successful in the eyes of the regulators. Unfortunately over the last few years the author has been in a quandary about something. Are NHS managers as a group of professionals, using policies that solved the wrong problem or solving the right problem, but still in the wrong way? Following this line of thought, the author wanted to ask "why don’t executives in the NHS make evidence based decisions? Methodology: A survey was conducted of the most senior NHS managers in the East Midlands. A set of interviews and participant observations of senior managers when making key decisions around current policy initiatives was recorded. This explored how the concept of evidence based management is perceived by the managers. The studied group were taken to have had career success and to be taken to be leaders in their field. The researcher was a senior manager within the same region of the NHS. The method additionally studied the effect of a discrete, but accepted piece of data upon the NHS as it struggled to adopt an evidence based response to the operational issue the data highlighted. The researcher was a planner within the same region that this data was being used and was responsible for responding to the data. The ontology used Bryman (2004) and Morgan (2007) to attach meaning to the views that members of that part of the NHS had of their world. Methods: Through taped recordings of meetings and verbatim transcripts of 1 to 1 interviews with senior managers the study recorded the awareness of a need for evidence (or not) and also analysed the collection and evaluation of evidence where such awareness did exist. Using a model developed by Rousseau (2006) the study classified the responses. Interpretation of the responses was shared with the participant and conclusions drawn against the Rousseau based model. Findings: Senior managers approve of evidence as it gives them a systematic view of what their staff are qualified to do and a requirement for evidence based decision making is part of the scheme of delegation. Adoption of innovation and research is a complex and often drawn out process. The adoption of research evidence is not a single discrete event. Managers will only use research if it improves the organisations standing. Finally, it is shown that there are credible and complex reasons for the failure in NHS managers to use evidence very often, despite the prevailing orthodoxy of evidence based medicine. The researcher agrees with McDaniel (2009) that evidence should be used to start new creative methods of working. Although Arndt and Bigelow (2009) raise objections against evidence based decision making as “decisions do not necessarily lead to expected outcomes” The researcher finds their work cautionary rather than impeding to what Banaszak-Holl says are “compelling arguments for moving forward with developing EBM".
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.B.A.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available