Developing a Model of Evidence-Based Management for Iranian Hospitals

Abstract

Abstract Introduction: Evidence-based management (EBMgt) has been developed as a management model for improving the quality of management decisions. Hospital managers’ decisions can have a significant impact on service effectiveness and hospital success. Using an evidence-based approach can improve hospital management. Purpose: Our purpose therefore is to develop EBMgt’s model for Iranian hospitals that it will be led to improve the managers practice during decision making process. Therfore, EBMgt’s model can be good guide for managers at all levels of management. Method and Materials: Mixed- methods were used to design EBMgt’s model that it were conducted using quantitative, qualitative and systematic review methods during 7 years ago (7105-7107) at Tabriz University of Medical Sciences (TUOMS). Participants in the qualitative phase were experts of health policy, economics, management, researchers and hospital managers (n=28). In quantitative phase, of 657 managers, 208 managers (62.076) of public hospitals and all the managers of hospitals (public, social security, charity and military) were included in Tabriz city. In the qualitative phase, a series of structured interviews and focus group discussions (FGDs) and in the quantitative phase, questionnaire were used for collection of data. Quantitative and qualitative data analysis methods were used in this study. Also, meta-analysis and meta-synthesis were used for data analysis of systematic review. Findings: The results of data analysis (systematic review, qualitative data, Delphi data and quantitative data) identified and confirmed the factors affecting the EBMgt. The results showed that EBMgt model (Including: micro context, macro context, structure, process and outcome) have been consisted of 6 evidence sources (with 71 sub-themes), 6 main steps of EBMgt process, 5 barriers to EBMgt (with 26 sub-themes) and 5 Facilitators of EBMgt (with 27 sub-themes). The EBMgt’s model for Iranian hospitals were developed by synthesizing of identified factors. The results of EBMgt assessment of Iranian hospitals showed that 59.70 percent respondents based their decisions on scientific-research evidence (SRE). Most health services managers based their decisions on SRE (66.576). Structural equation modeling (SEM) indicated that all the facilitators of EBMgt and sources of evidence have a significant and positive relationship with EBMgt (p<1.15). Also, facilitators have a significant and negative relationship with barriers to EBMgt (p<1.15). Conclusions: Our study suggests that most participants have positive attitudes towards EBMgt. This study showed that a full evidence-based hospital manager someone who is using all the sources of evidence for making hospital decisions. Using hexagon of evidence sources, managers can identify the best available evidence for hospital decisions and to make the best decision in the process of evidence-based decision making.