Evidence‐based medicine: what about evidence‐based management?

Evidence-based medicine: what about evidence-based management?Do we get the best value from the investment in health care?What is known about the outcome of clinical interventions?To what extent does clinical practice follow the best available scientific evidence?These questions, posed by the King's Fund (Coulter 1996), summarize the current concern with Evidence Based Medicine (EBM) in health care.Coulter goes on to contend that the promotion of clinical effectiveness must be the overriding priority for the National Health Service (NHS), demonstrating that EBM is a central policy issue.It is regarded as the solution to problems which have characterized health care in recent years, particularly in relation to expenditure.It is assumed that if interventions are based on evidence and can be linked to clear, measurable outcomes then the funds allocated to health care can be spent wisely and value for money achieved (Maynard 1994).Yet in common with other issues in health care, the picture is not quite so straightforward.However, the current concern with EBM draws attention to another area of contemporary practice which also lacks evidence concerning its effectiveness: management.If a comparison is made between the contrasting approaches taken to EBM and management, a case can be made for suggesting that the work of health managers should also be subject to greater scrutiny.In order to demonstrate this the arguments surrounding EBM will be briefly rehearsed before moving on to consider an initiative which has been pursued without any substantial basis of evidence: the management reforms. of the NHS.The demands being made of clinicians to provide evidence for their actions will be contrasted with the criteria for success of managers, namely the achievement of arbitrary targets such as throughput and waiting times expressed in numerical form, which arise from the imposition of a particular model of management.Finally, it will be suggested that if managers and clinicians are to work together effectively to deliver health services in the future both groups must have recourse to appropriate evidence to justify their actions.