From the Officer’s Desk: Evidence-Based Management 

With enough time in the medical fields, you’ve likely heard statements like, “It has to be evidence-based,” or “Show me the evidence.” Ideally, all the treatments and procedures we perform in the prehospital setting would be evidence-based. But when was the last time you heard an organizational leader ask for the evidence pertaining to a proposed decision or project?

Evidence-based initiatives are not only part of medical profession but are also used in management and leadership, human resources, education, and other fields. EMS officers can benefit from using evidence-based approaches when working through management decisions.

What Is Evidence-Based Management?

As EMS officers, we routinely work with our medical directors to incorporate evidence-based treatments into our departments’ clinical protocols—for example, the use of bougies for endotracheal intubation, tranexamic acid to stop hemorrhage, high-performance CPR as part of every resuscitation, and transporting acute stroke patients to stroke centers all have benefits supported by data. 

The inspiration for evidence-based management comes from the same concept. Like evidence-based medicine, evidence-based management uses scientific evidence to inform decision-making and problem-solving. Using an evidence-based approach transitions the bases of these decisions from biases, individual experiences, and fads to research-based evidence. Of course, not all decisions need to be evidence-based; however, it is certainly worth the effort to determine what evidence is available that might be helpful when making high-level decisions. Simply put, it helps reduce errors!

Consider an example: EMS leaders know most 9-1-1 calls only require BLS care. However, some fire and EMS organizations continue to provide all-ALS responses. Although the evidence indicates BLS calls outnumber requests for ALS services and all-ALS departments carry greater personnel costs, the all-ALS model persists. Why? The usual response is, “This is how we’ve always done it,” or “The more paramedics on scene, the better.” Evidence suggests that’s not necessarily true. EMS officers have a responsibility to review their data, do their research, and not continue the status quo because it made sense once. 

Evidence-based management, as with evidence-based medicine, is driven by trusted and unbiased research. The Chartered Institute of Personnel and Development and the Center for Evidence-Based Management recommend the following six steps when working through a decision-making process: 

• Asking—Translating a practical issue or problem into an answerable question
• Acquiring—Systematically searching and retrieving the evidence
• Appraising—Critically judging the trustworthiness and relevance of the evidence
• Aggregating—Weighing and pulling together the evidence
• Applying—Incorporating the evidence into the decision-making process
• Assessing—Evaluating the outcome of the decision. 

As part of evidence-based management, organizations’ leaders must consider the following four sources for gathering evidence prior to making any decisions: 

• Internal organizational data—Utilize whatever relevant data exists within your organization.
• Professional expertise—Seek input from industry experts and contacts. 
• Stakeholder values and concerns—Use focus groups, customer experience surveys, and face-to-face interviews to gather information from those who have made similar decisions and can offer insights.
• Insight from scientific literature—This includes peer-reviewed published research and must be prioritized over opinions or best practices that lack validated support. Find this evidence in reputable professional journals and online by searching sources like PubMed, Google Scholar, and WorldWideScience.org, to name a few.

Evidence in Action

The following are examples of how evidence-based management has worked for well-known organizations.

• A study at Google clarified what Google leaders believed to be the most important quality in a manager, which was deep technical expertise. However, when Google examined what employees valued most, technical expertise ranked last. Google employees preferred a manager who cared about their employees and took time to meet with people.
• In 2015 Walmart experienced a decrease in revenue for the first time in 45 years. Only 16% of stores were meeting the organization’s goals, and customers had complaints that ranged from dirty bathrooms to endless checkout lines and an inability to find employees to assist them. Walmart conducted an experiment that included increasing employee wages, increasing training, and providing employees with consistent schedules. The results were positive, and by 2016 75% of stores were meeting their targets as sales were rising again. Walmart executives transitioned from cost-cutting to evidence-based decision-making. 

In both cases leadership teams were conducting business in a manner they believed was the best approach. However, they did so without evidence, resulting in suboptimal outcomes.

Barriers

If using evidence-based management can help us make better decisions and reduce the likelihood of errors, then why not use it more often? Ideas like researching scientific literature, gathering internal statistical data, and conducting interviews might deter the inexperienced. EMS officers must not be intimidated to conduct research but rather immerse themselves in the process, and with time it will become part of doing business. 

In addition, understand that conducting research takes time. This is also a reason managers may choose not to invest in evidence-based management. Moreover, interpreting data, as it may include scientific terminology and statistics, can also be a challenge for those who do not routinely conduct research. Having limited resources and not having buy-in from senior leadership can also be barriers.

As EMS officers we must demand evidence-based facts underlying our decisions, whether they be medicine or management. Having the tools and information to make well-informed decisions will benefit our organizations and our patients.

Orlando J. Dominguez, Jr., MBA, RPM, is assistant chief of EMS for Brevard County Fire Rescue in Rockledge, Fla. He has more than 30 years of EMS experience and has served as a firefighter-paramedic, flight paramedic, field training officer, EMS educator, and division chief. He hosts the EMS Officer Exchange podcast; has authored two books, including EMS Supervisor: Principles and Practice; and is a certified Lean Six Sigma Black Belt. Follow him at @ems_officer.