Wednesday, December 22, 2010

Evidence Based Management?

It is the Christmas break. I am scheduled to take a course at Medical College of Georgia (online) beginning in January and have been reading the textbook as a way to prepare. One think in particular caught my eye. It is the idea that because evidence-based clinical practices have proven to be valuable that evidence-based managerial practices are also necessarily a good thing. The first thing that comes to mind is Herbert Simon's paper on the Proverbs of Administration. What seems like a "sure bet" may not be. Some people swim upstream and get awards for doing so. Others just swim upstream.

I believe that there are some fundamental differences between clinical practices and managerial practices. Assuming evidence-based clinical practices are a good thing I question that that necessarily implies that evidence-based managerial practices are necessarily always good. For the moment, let me reflect on just one difference. Clinicians are not in the business of designing the systems that they seek to heal. The basic design of human bodies is pretty much what it is. Strategic level managers, however, do design organizations. Making a decision regarding whether or not to merge two existing provider-organizations is not something with a parallel in the clinical world at present. And to say that two hospital systems should not have been merged because there was some prior evidence of failures does not require a new term such as evidence-based management. We have always known that it is good to learn from history while realizing that history is a guide rather than a set of deterministic rules. In clinical practices there are usually large numbers of prior cases from which to observe outcomes. The variations tend to smooth out individual differences. In strategic management there are usually fewer cases upon which to ponder.

But to return to a previous observation, in high-level management decisions are being made about the design of things. Organizations are more fluid in prospective designs than organisms. I certainly do not oppose the application of critical thinking skills to strategic management. I am only questioning what is gained by the introduction of the phrase, "evidence-based management" and the assumption that because evidence-based medicine is a good thing that the association to management adds anything to the fact that we already accept that managers should learn from experiences, have a systems perspective and anticipate the range of possible consequences of their decisions.

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