(Editor's note - This is the first of a two-part series on evidence-based management by guest columnist Steve Miller of Open BI. Part 1 discusses the medical roots of an evidence-based approach. Part 2 addresses the important application of evidence-based concepts to business management.)
Evidence-based management (EBM) is a self-descriptive term for the application of scientific and statistical principles to decision-making. While this sounds like another spin on a business intelligence or clean-data exercise, the roots of the practice come from another EBM - evidence-based medicine. While little exists today in terms of a formal practice in the management sense, a case example from the medical field can demonstrate the analogous business value through judicious use of evidence in weighing cost/benefit, risk management and other measurements of success or failure.
A Case Example
My neighbor recently went through a health crisis. Jack had turned 50 in the past year, had a family history of heart disease, and was experiencing severe episodic pain in his chest and shoulder. An EKG administered by his family doctor was inconclusive, as was a stress test performed by his cardiologist. With no relief and many unanswered questions, Jack and his cardiologist decided on a surgical procedure wherein dye is injected through a catheter into suspect arteries. X-ray images are then used to accurately determine the extent of blockages in the tested arteries.
Early procedure feedback from the cardiologist was not encouraging: Jack had blockages in several coronary arteries. He started mentally preparing himself for a bypass procedure, or better perhaps, a less-intrusive angioplasty involving the insertion of mesh tubes or stents. To Jack's surprise, the cardiologist - who had built a lucrative practice performing angioplasties - proposed a more measured, conservative approach.
The treatment outlined for Jack included a mid-level dose of a cholesterol-reducing drug, a daily exercise regimen, and an aggressive weight-loss and dietary plan to reduce saturated fats. The goal was to reduce Jack's LDL cholesterol level to 70, and increase his HDL to 50 or more. Jack was relieved and enthusiastically endorsed the proposed plan.
As their interaction was winding down post-procedure, Jack, a pharmacist, confided his surprise in the conservative approach to the cardiologist. The cardiologist remarked that his recommendation would have been different three or four years ago, and dramatically different six to seven years ago when less was known about the relative effectiveness of the different surgical options. Citing less-than-stellar evidence from clinical and epidemiological studies, the cardiologist opined that consistent findings of undifferentiated outcomes for bypass surgery and angioplasty in cases like Jack's argued for a conservative approach to treatment. In his opinion, the inadequate upside benefits of the surgical procedures didn't justify the added risks. Jack probably didn't realize it at the time, but by proactively seeking the best clinical research on treating moderate blockages in coronary arteries, and then evaluating and adapting his clinical approach to the knowledge he gained, his cardiologist was practicing evidence-based medicine.
Evidence-based medicine has been characterized by David Sackett of Oxford as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients...integrating individual clinical expertise with the best available clinical evidence from systematic research".
The evidence-based (EB) paradigm can be profitably viewed as a foundation for life-long, objective, problem-based learning. The steps of an EB method include:
- Translating information to questions to information;
- Finding the best available research and accumulated evidence to answer the questions;
- Judging the evidence for validity and clinical utility;
- Using professional judgment to apply the findings in practice; and,
- Evaluating the performance of the chosen treatment in practice.
The evidence-based approach is obsessed with driving "strategy" from the results of rigorous research - finding and judging the evidence - then measuring and evaluating that strategy in action, making modifications as indicated. Experiments, intelligence and evaluation are thus central to effective EB solutions. Indeed, the health sciences have authored an evidence hierarchy that rates the quality of research findings used to guide evidence-based treatment. Table 1 prioritizes designs from 1, most rigorous, to 8, of little value. Solid findings from randomized trials or cohort studies, for example, are considered superior evidence for the efficacy of treatment in contrast to, say, positive acknowledgements from case studies. EBM practitioners well understand the distinctions in quality of these research designs, incorporating that knowledge in determining treatment approach, able to "integrate clinical expertise with the best available evidence from research."
An article in the Business Section of the June 5, 2007 Chicago Tribune entitled "Drugs in comeback against artery stents" summarizes well the issues surrounding current treatments for coronary artery disease and the ascendance of evidence-based medicine. Citing a controversial study that argues stents and angioplasties are no more effective in preventing heart attacks than drug therapy, along with documented blood-clotting side effects of some drug-coated stents, the article notes the "conflicts" of physicians who must sort through the welter of evidence as advocates for their patients. "If you don't question what you do on a daily basis, you are not being responsible; so, appropriately, there is always a reevaluation and rethinking." said Dr. Peter Kerwin, medical director of the cardiac catheterization lab at Advocate Good Samaritan Hospital in Downers Grove.
Part 2 of the series will apply the EB concepts to business management.
Table 1: Evidence Hierarchy
- Bruce Japsen. Drugs in comeback against artery stents. Chicago Tribune. June 5, 2007.
Steve Miller is co-founder of Chicago-based business intelligence services firm OpenBI, LLC. He can be reached at email@example.com.
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