critical thinking and evidence based management is closely related to the theory of

Rethinking Evidence-Based Management

• Published: 15 May 2023
• Volume 23 , pages 59–84, ( 2024 )

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• Erik Weber   ORCID: orcid.org/0000-0002-0339-3810 1 ,
• Ann Wyverkens   ORCID: orcid.org/0000-0003-1299-3532 1 &
• Bert Leuridan   ORCID: orcid.org/0000-0001-5962-5652 2  

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Evidence-based management (EBMgt) is a relatively recent approach to management, developed by Denise Rousseau in a series of articles and in a book that she co-authored with Eric Barends (Barends & Rousseau 2018 ). It is based on the idea that good-quality management decisions require both critical thinking and use of the best available evidence. In this paper we want to contribute to the scholarship on evidence-based management by showing how its central concept – evidence – can and should be defined more strictly. Barends and Rousseau define evidence as a two-place relation between information and a claim that is at stake. Starting from insights from the methodology of the social sciences we argue that evidence is a three-place relation between a method , information and a claim. We offer a guiding principle for adequately characterising what counts as evidence (the inclusion of a procedural component which describes how the information should be collected and reported) and apply it to Barends and Rousseau’s concepts of (i) evidence from practitioners, (ii) evidence from the organization and (iii) evidence from stakeholders. We think that by treating evidence as a three-place relation we can develop an improved account (which we call EBMgt+) of what evidence-based management can and should be.

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While Eric Barends and Denise M. Rousseau are listed as the authors, four other scholars contributed to the book as well (Rob Briner, Barbara Janssen, Martin Walker and Alessandra Capezio). Where we write about ‘the authors’ of the book, that may refer to these contributors too (depending on the chapter of the book we quote or paraphrase).

There has been debate about the proper way to assess the effectiveness of EBMgt on a meta-level; see for instance Briner, Denyer and Rousseau’s ( 2009 ) reply to Reay, Berta and Kohn’s ( 2009 ) systematic review of (what Reay and colleagues took to be) the then available evidence about EBMgt.

The main issue is not about sampling methods but about good versus bad ways to search for scientific studies in databases.

We implicitly assume that the other quality conditions hinted at in the fourth section are satisfied as well.

To repeat, we implicitly assume that the other quality conditions hinted at in the fourth section are satisfied as well.

The concept of ‘causal model’ is not rigorously defined. Barends and Rousseau describe it both as “a short narrative that explains why or when the problem occurs (= cause), and how this leads to a particular outcome (= effect)” ( 2018 , p. 29) and as “a graphic representation of the logical connections between inputs (resources, antecedents), activities and processes (what is done to inputs), outputs and outcomes (immediate results and longer-term consequences)” ( 2018 , p. 195).

Sampling (and a fortiori probability sampling) is not required if the relevant information can be acquired exhaustively (for instance because your company only has few employees or because performance statistics are already available for all employees in the company).

One more time, we implicitly assume that the other quality conditions hinted at in the fourth section are satisfied as well. We also implicitly focus on cases where sampling is needed (because the relevant community of stakeholders cannot be investigated entirely).

Arber, Sara. 2001. ‘Designing Samples’, in Nigel Gilbert (ed.), Researching Social Life (2nd edition). London: Sage Publications, pp. 58–82.

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Acknowledgements

The authors thank the audience at the OLOFOS seminar (Louvain-la-Neuve), the PSF2022 conference (Leusden) and the SPSP2022 conference (Gent) for their comments on previous versions of this paper. We also thank both reviewers for insisting on the elaboration of the practical consequences in management contexts of our views which are inspired by insights in the philosophy and methodology the social sciences.

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Weber, E., Wyverkens, A. & Leuridan, B. Rethinking Evidence-Based Management. Philosophy of Management 23 , 59–84 (2024). https://doi.org/10.1007/s40926-023-00236-5

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Evidence-Based Management: From the What and the Why, to the How To

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The central premise of evidence-based practice (EBP) is that decisions are more likely to be successful when they build on critical thinking and the use of the best available evidence – which is easier said than done.

In the past decade, leading figures on EBP in Management and Leadership at the Center for Evidence-Based Management (CEBMa) have been developing a framework to make effective people decisions. In short, this comprises a clear decision-making process and skills and techniques to critically evaluate evidence from multiple sources :

However, up until now, the debate in the evidence-based management movement was centered more on what is it and why do we need it , than on how you do it . But now we are progressing : several practitioners in organizations are being trained on the principles and know-how to make evidence-based decisions, and interest – and commitment – of professional bodies and organizations is raising.

So, the question is: how are we doing with skill-development for Evidence-Based Practice in Management and HR?

Evidence-Based HR: From Theory to Practice

The first full-blown, 3-day training course on evidence-based decision-making took place this Fall in Belgium. Here CEBMa, Ghent University, and Balance HR, partnering with The VIGOR Unit, WisKeys, and ScienceForWork, had a deeper look at what it takes to apply an evidence-based approach to management decisions. The training had a unique format–and venue–and was the first of its kind .

Photo credits: Raf Michiels ( www.rafmichiels.com)

The training was organized by Balance HR , a network of HR freelancers that advises and supports HR leaders on temporary assignments, and involved 12 HR leaders and managers from mid-to-large organizations. The leitmotiv was that HR decisions should be based on high quality evidence, not hunches .

Primary focus were concrete issues and challenges typically faced by HR professionals

The training used a blended learning approach that integrated interactive classroom sessions , e-learning modules and coaching (during and after the 3-day course). Starting point were concrete issues and challenges typically encountered by HR professionals.

In synthesis, the training demonstrated how to approach real-world issues from an evidence-based perspective . The focus of Day 1 was building Evidence-Based Skills : asking critical questions and surfacing assumptions (i.e., making the implicit, explicit); identifying cognitive errors and evaluating the robustness of professional judgement; acquiring evidence from experienced professionals and stakeholders; finding, critically appraising, and translating scientific evidence for practice.

Day 2 was all about Evidence-Based Insights . Participants learned insights from the best scientific evidence on performance management and appraisal, talent management, recruitment and selection, motivation, engagement, incentives, and more. Hence, everyone defined which practical questions to ask and retrieve scientific evidence for, and practiced how to quickly find, make sense and use the best available scientific evidence to inform people decisions .

After a pause of two weeks where trainees had fun looking at the science behind their organization’s challenge, the group got together again in Day 3 to Put It All Together . Challenged by leading authorities in the domain of evidence-based management, Professor Rob Briner, Professor Frederik Anseel, and Dr. Eric Barends, trainees presented the result of their own research and drew up an action plan to apply the principles learned to their organizations.

Evidence-Based Practice in Management and HR is about “a common responsibility to make work better”

Talking to Edward Vanhoutte, Managing Partner at Balance HR, and main organizer of the training course, the main takeaway is that the need for evidence-based practice is strong, and a growing number of practitioners are keen to take responsibility: “In medicine, where Evidence-Based Practice originated, evidence is of vital importance. In management, we do not speak about a matter of life and death, but people-related management decisions do have an immense impact on our work and thus on our lives. Given the fact that most people spend most of their adult lives at work, we better make it valuable, for everyone involved. To quote one of our course instructors, Prof. Denise Rousseau, it’s about a common responsibility to make work better.”

Edward added that “Basing people related decisions on the best available evidence is a more responsible and effective kind of management. It doesn’t mean we should become evidence-based fundamentalists. People will not be convinced by reason only. Having an inspiring purpose is at least as important to move people and to realize progress. In short, a soft mission on a hard, evidence-based fundament.”

Whereas the necessity of Evidence-Based Practice becomes more obvious, there are still misconceptions.  “Many practitioners still have the idea that evidence-based HR is for academics and is too theoretical for them. Gathering, understanding and using evidence from multiple sources indeed requires a set of specific skills […] however, we showed them that there are user friendly ways to realize this, and to obtain outcomes which are practical to use.”

Furthermore, Edward pleads for a gradual implementation and a constructive approach, rather than mainly taking down current practices. Because each context is different, it may be appropriate to experiment with the proposed evidence-based alternatives and evaluate the outcomes of decisions.

Ultimately, while evidence-based HR requires a dose of healthy skepticism around claims being made, “it is not about pissing people off, rather it’s all about doing useful work to solve real problems” as Managing Director of CEBMa, Dr. Eric Barends, puts it.

HR Professionals see the importance of starting out on concrete problems and using also scientific evidence to make people decisions

Recurring theme from all trainees was appreciation for the relentless focus on identifying the problem you need solving, and avoid the phenomenon of solutioneering (i.e., defining the problem by the absence of a solution, for example, employee engagement , ref. Prof. Briner).

An Vanderdeelen, Talent Manager at Partena Professional, told us that she attended the training because “the idea of a more solid approach to Human Resource Management was appealing […]; in HR we hire, onboard, develop, reward employees without accounting for what scientific evidence suggest works better or doesn’t work, in what circumstances or why. The gap between practice and research is a problem here. At the same time, dozens of renowned consultants claim their approach or solution is the holy grail to every organizational challenge […] so, we are often tempted to go with the “easy fix” rather than take the time to gather the best available evidence to answer the question ‘what is the problem do I need to solve?”

In fact, as physicist Albert Einstein once put it, “if I had an hour to solve a problem I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions”. This feeling was confirmed by Joëlle Dekeyser, HR Partner at Balance HR, who told us that “asking the right questions to identify the problem, its consequences and root causes, daring to challenge assumptions, and learning how to judge the quality and trustworthiness of the evidence from different sources” were some of the key ingredients that stood out in the training which distinguished an evidence-based approach from business-as-usual.

Overall, shifting to an evidence-based approach when dealing with problems or opportunities doesn’t happen overnight . Since developing skills requires practice, the more you apply the evidence-based framework to understand problems and develop solutions, the better you should get at it and make it a habit. All in all, as trainees often exclaimed “ this is not rocket science! “, rather it’s about questioning the way we reach conclusions, and getting ourselves to think smarter.

Training on Evidence-Based HR: Who’s next? Ask the Chartered Institute for Personnel and Development (CIPD)

This first occasion showed that now practitioners have the means and know-how to apply an evidence-based approach in organizations to solve complex issues and challenges . But does this mean that Evidence-Based HR going mainstream? There are signs we are at the beginning of its large-scale uptake. In fact, the main professional body in the UK, the CIPD, led by CEO Peter Cheese, has recently announced a new Professional Standards Framework for its 144,000+ members in which Evidence-Based Practice is set as cornerstone of management practice . It’s likely others will follow suit. CIPD’s engagement with Evidence-Based HR followed an official acknowledgement that today more than ever, decisions should be based on strong evidence , rather than fads and fashions .

In this context, the training on the how to of Evidence-Based HR that we’ve been describing above will now be provided by the CIPD . So, the professional body positions itself as UK-based leading provider of courses on Evidence-Based Management and HR which apply evidence-based learning and teaching standards of CEBMa. You can read of this, and other key initiatives aiming to facilitate the uptake and implementation of Evidence-Based Practice in Management and HR , in the latest Newsletter of the Center for Evidence-Based Management .

Pietro Marenco

After taking a MS degree in I/O Psychology from the University of Bologna (IT) and the University of Valencia (SP), Pietro currently works as Freelance R&D Consultant as Fellow of the Center for Evidence-Based Management. He believes there’s always a better way of doing something, a for clearer purposes. Pietro loves a myriad of things, but is particularly keen about turning kitchens into restaurants.

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Management Decision

ISSN : 0025-1747

Article publication date: 25 May 2012

The purpose of this paper is to integrate existing body of knowledge on evidence‐based management, develop a theory of evidence, and propose a model of evidence‐based decision making.

Design/methodology/approach

Following a literature review, the paper takes a conceptual approach toward developing a theory of evidence and a process model of decision making. Formal research propositions amplify both theory and model.

The paper suggests that decision making is at the heart of management practice. It underscores the importance of both research and experiential evidence for making professionally sound managerial decisions. It argues that the strength of evidence is a function of its rigor and relevance manifested by methodological fit, relevance to the context, transparency of its findings, replicability of the evidence, and the degree of consensus within the decision community. A multi‐stage mixed level model of evidence‐based decision making is proposed with suggestions for future research.

Practical implications

An explicit, formal, and systematic collaboration at the global level among the producers of evidence and its users akin to the Cochrane Collaboration will ensure sound evidence, contribute to decision quality, and enable professionalization of management practice.

Originality/value

The unique value contribution of this paper comes from a critical review of the evidence‐based management literature, the articulation of a formal theory of evidence, and the development of a model for decision making driven by the theory of evidence.

• Evidence based management
• Theory of evidence
• Mixed level model of decision making
• Global collaboration
• Management strategy
• Management theory

Baba, V.V. and HakemZadeh, F. (2012), "Toward a theory of evidence based decision making", Management Decision , Vol. 50 No. 5, pp. 832-867. https://doi.org/10.1108/00251741211227546

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Better Business Decisions, Without the Bias

May 20, 2021

Catherine Daly

Forget conventional wisdom, you need evidence-based management.

What else, besides evidence, do you use to make decisions? 

This may seem like an odd question to most leaders—especially in a world where we have so much data at our fingertips. But, as it turns out, there are a lot of other factors that affect our decisions, whether we intend them to or not.

We make hundreds of decisions every day—from the coffee we order to the candidate we select for an interview—and hype, bias, opinion, belief systems, ego, and stress influence our choices.

Evidence-based management is an approach that involves consciously setting aside the accepted conventions and hierarchy of opinion, and instead, using critical thinking and the best available evidence to make decisions. Using it to make managerial and people-related decisions can drive better outcomes in every aspect of a business, from diversity and inclusion to profitability .

→ Download Now: How to Gather Effective Field Intelligence in the Digital World

Table of contents

What is evidence-based management, how to use evidence-based management, sources of evidence for leaders, tools to enable evidence-based management.

Have you ever made a decision based on so-called "best practices"? If you have—and if you haven’t questioned the culture, myths, and ideologies that contributed to those practices—your decision-making framework is fundamentally flawed.

Falling back on acquired best practices can result in bad decisions, poor business outcomes, and a limited understanding of why things went wrong in the first place. Adoption of evidence-based management approaches can prevent this.

Evidence-based management is a practice of management and decision-making based on critical thinking and reliable evidence. The practice became popular in medicine in the 1990s when a Canadian-American physician, Dr. David Sackett , defined evidence-based practice as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”

While this sounds like a pretty basic expectation of medical practitioners, there are many cases where stress, workload, and other factors hinder decision-making and result in poorer patient outcomes. In the last decade or so, evidence-based practice spread to other disciplines like public policy, education, and business management.

Evidence-based management makes us more effective and accountable leaders and delivers better outcomes for our organizations. The  Chartered Institute of Personnel and Development (CIPD) and the Center for Evidence-Based Management (CEBMa) outline six steps you can follow to increase the likelihood of a favorable outcome from your decisions:

• Asking: Translating a practical issue or problem into an answerable question
• Acquiring: Systematically searching for 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

The third step — critical appraisal —plays a central role in evaluating the quality, trustworthiness, and relevance of the evidence used to make decisions. To do this, you should ask yourself questions like:

• Where and how is the evidence gathered?
• Could the evidence be biased in a particular direction?
• Is it the best available evidence?
• Is there enough evidence to reach a conclusion?

In this way, not only are you gathering evidence from many sources, but you're also prioritizing it and thinking critically about the validity of it instead of taking it at face value.

According to the principles of evidence-based practice , there are four sources of evidence to consider before making any major decisions:

• Scientific literature

Knowledge from scientific evidence is more accurate than the opinions of experts or their best practices. Scientific evidence includes published peer-reviewed research (often in management or other academic journals) and primary research from trusted, unbiased industry sources.

2. Internal data

Professional judgments based on hard data are far more accurate than judgments based on individual experience. 

3. Professional expertise

The professional experience   of many people results in more accurate decisions than the personal experience of one or two individuals. Connecting with industry association members and peer networking can help provide us with more well-rounded perspectives on our decisions.

4. Stakeholders’ values and concerns

Consulting the people affected by our decisions can be done with focus groups, internal surveys, or—more efficiently—through enterprise discussion management tools.

Evidence-based management is not as straightforward as it sounds—it takes effort to adopt these practices across an organization. But, thankfully, several tools can help us facilitate an evidence-based culture.

• Subscriptions to academic journals

When was the last time you read an academic journal? For many reasons—including time constraints and cognitive overload—we often look for the personal experience of other managers or best practices rather than seek out new ideas.

Whatever field you’re in, you can be sure there are academic journals to support your skills development. We’re all lifelong learners, after all. Moreover, every practice evolves, and staying in tune with the latest academia helps us avoid falling into the best practices trap so we can think critically about the evolution of our respective disciplines.

JSTOR, Directory of Open Access Journals, and ScienceDirect are just a few of the many databases that house academic journals that can help support our evidence-based decisions.

2. Business intelligence tools

Internal business data is an essential source of evidence. Hard data can come from our customer relationship management (CRM) tools like Salesforce or enterprise resource planning (ERP) tools like Netsuite.

Even with all of these tools, many of us struggle to integrate our data across the business. Leveraging your organization’s business analyst or data science team is a good way to ensure the data sets you’re using to make accurate decisions. 

Advanced business intelligence like Tableau can help us bring some of that data to life with visualizations that offer clearer insights.

3. Membership to industry associations

In the age of ubiquitous information available online, why would you choose to spend hundreds of dollars on industry association memberships? Because they give you access to perspectives outside of your personal experience and distinct from your organization’s experiences. 

Information and perspectives from other experts in your specific industry are invaluable to evidence-based management. 

4. Enterprise discussion management 

Enterprise discussion management solutions are critical in helping us connect our workforce and gauge stakeholders’ values and concerns about a specific topic. 

In the past, you may have used surveys or polls to understand your employees’ alignment on strategy or to tap into their ideas. However, these tools make it nearly impossible to hear their honest perspective because they require participants to choose from pre-populated answers. Focus groups can uncover deeper insights, but they’re time-consuming, expensive, and only let you access a small range of perspectives.

Using discussion management software like ThoughtExchange, you can ask your team or entire organization an open-ended question in what’s called an Exchange. Your participants share their thoughts with the group anonymously and rate each others’ ideas, and the highest-rated ideas rise to the top. The built-in anti-bias technology ensures ratings are based on merit, not on the person sharing—or how loudly they share. All of this happens in a matter of minutes, and our value-rich analytics make it quick and easy to synthesize the data into actionable insights. 

ThoughtExchange gives you insight into a big group of people in a short amount of time and makes internal evidence gathering easy for leaders. 

The Future of Decision-Making is Evidence-Based

Evidence-based management approaches can change how we think and act for the better. By using better, deeper logic, employing facts from a range of sources, and filling your evidence gaps with discussion management software like ThoughtExchange , we can do our jobs more effectively and build healthier organizations.

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‘Evidence Based Management’, or ‘Evidence Oriented Organizing’? A critical realist perspective

• Published 1 March 2013
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Learn what really matters based on evidence: An Introduction to Evidence-based Management

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• Science-based and Evidence-based Management

 Executive summary

Evidence-based management is the practice of selecting management strategies and interventions that have been supported by scientific research as one of four sources of evidence (Barrends, Rousseau, & Briner, 2014). While a wealth of high-quality, evidence-based research currently exists in the field of management, many managers still use less reliable means of making decisions, such as following anecdotal evidence or popular trends (Rousseau, 2006; Rynes, Colbert, & Brown, 2002). However, with some training in the core principles of locating, evaluating, and reading empirical research, any manager can become capable of rooting their decisions in science rather than speculation.

•  Executive summary

What is Science-based and Evidence-based Management?

Peer review, documentation of data and methods, appropriately grounded conclusions, where to find evidence-based management knowledge, introduction section: research question and topic background, methods section: research approach and implementation, results section: research outcomes, discussion and conclusion section: result interpretation and recommendations, limitations of scientific evidence, the four sources of evidence, key take-aways, references and further readings.

To be an evidence-based manager is to rely on properly analyzed data and critical, scientific thinking to make substantive decisions. This can be contrasted with making decisions based on anecdotal (story-based) evidence, personal experience, popular trends, or informal theories that have not been adequately tested (Pfeffer & Sutton, 2006). Evidence-based managers conduct reviews of the empirical literature prior to selecting strategies, and root their choices in what the data generally shows, rather than what their gut instincts or personal biases tell them (Bazerman, 2009).

The benefits of taking an evidence-based approach are numerous. Evidence-based management tends to be rooted in the documented, carefully analyzed experiences of many managers, as well as social scientists. In empirical studies, participants groups are large, and include employees at a variety of organizations. This large and diverse sampling increases the accuracy of findings. Conclusions arrived at via evidence-based approaches are less likely to be random, and are more likely to be reproducible and applicable to a wide variety of settings, compared to conclusions arrived at via less scientific means (Sanders, van Riemsdijk, & Groen, 2008).

Evidence-based management also tends to rely on more objective and systematic analyses of data. Human bias can lead to inaccurate conclusions and biased interpretations of events. Managers may, for example, misremember their attempts at introducing a new strategy, recalling only the instances where that strategy worked, and conveniently forgetting or discounting experiences when it did not (Tschan et al, 2009). This can lead to inaccurate conclusions about a strategy’s efficacy. By using the scientific method to more objectively test predictions and analyze data, evidence-based conclusions are higher in accuracy and less likely to be biased.

Defining and locating evidence-based data and information

Individuals without formal scientific training are often unaware of how to seek out trustworthy, high-quality evidence-based information. Outside of social science graduate programs, very few people are trained in how to seek out research and evaluate it. The core principles of finding good evidence, however, are relatively straightforward:

• Information should come from a peer-reviewed or otherwise appropriately vetted source,
• methods and data should be fully and clearly documented within that source, and
• conclusions should be rooted in a grounded, accurate interpretation of results.

These requirements, and how to search for quality evidence-based information, are described in further detail below.

High-quality research must have undergone peer review, a lengthy, formalized process wherein at least three experts in the field provide detailed feedback on a report (Spier, 2002). For academic journals, the peer review process is highly selective, with only a small minority of articles ultimately earning publication, following rounds of revisions. The selectivity and expert vetting inherent to this process helps ensure that published work is credible and properly conducted (Jefferson, Wager, & Davidoff, 2002). Peer-reviewed research is most commonly found in academic journals or periodicals, but peer-review is sometimes also performed on chapters of academic texts or on presentations for professional conferences.

In addition to being peer-reviewed, quality evidence is well documented. Researchers should be willing and able to share their original data with colleagues when requested, along with the results of statistical analyses. This establishes credibility and allows for double-checking of results. In some instances, the full data that an organization or research team has collected may be freely available online. This is particularly the case for national datasets collected by governmental and public agencies. High-quality research should also clearly document its methodology. In a well-written and trustworthy research report, the specifics of how the study was conducted, who participated in the study, and when and where the study took place will be evident to the reader. The instruments that used to measure variables should also be explained, as well as how data was stored. Clarity about methods allows other researchers to reproduce results, which provides additional verification.

Evidence-based information and conclusions must be firmly grounded in reality, with clear acknowledgement of limitations (Bem, 2004). No study can provide conclusive evidence that a management strategy always works, or that certain trends will always be evident. All research conclusions are specific to the time and place in which the study was conducted, and may be influenced by particular details of the sample demographics, study site, or sample size. Furthermore, all scientific conclusions are tentative, and open to further revision as additional evidence is collected over time. A responsible researcher will acknowledge these and other limitations, and not overstate confidence in their results.

To find evidence-based management information, seek out research databases such as PsychInfo and JSTOR. These sites compile all the published research from peer-reviewed academic journals, dissertations, and book chapters, and provide digital copies that go back decades. Useful, management-related research can be found in a variety of types of social science, communications, and management journals. Google Scholar is also a popular resource for scouring multiple research databases at a time, and allows for more flexible and dynamic search options. Restricting your search to specific locations or dates (using a database’s advanced search options) can help a manager locate findings relevant to their situation and purpose.

Another source of evidence-based management knowledge you should consider are online learning platforms like CQ. They bridge the gap between social sciences and practice in management by translating years of social science research into distilled, practical advice that is both empirically supported and easy to comprehend. This makes it easier for management practitioners to find, evaluate, interpret and implement high quality management knowledge in their organization without going through a vast amount of complex scientific studies.

Reading and making use of evidence-based information

When looking at peer-reviewed research articles, begin by closely reading the abstract. This brief summary of the study should outline the methodology and the results in fairly understandable language. If the abstract suggests that the article may be relevant to the manager’s questions and goals, the full article should be read (Bem, 2004).

The introduction section provides a background to the research question and topic at hand, with numerous citations to existing research. These citations can be located and read as well, for additional information on the topic. You will also find a link to models and theories the research paper relies on in the introduction section. For instance, goal setting theory is a theoretical framework which is the point of departure for many research articles and thus will be briefly introduced in most of those articles.

The methods section should describe exactly how the study was conducted, and should further help the reader to determine if the research is relevant to their goals. Depending on the type of the research article the methods section varies. On a high level you can distinguish between qualitative and quantitative research studies. Qualitative research usually relies on methods such as case studies, focus groups, semi-structured interviews or text analysis. Quantitative research is more inclined towards statistics with close-ended surveys, statistical tests and meta-analysis as methods of choice.

The results section of a journal article typically features statistical results, which may be daunting to read for managers who lack statistical expertise. However, this section shouldn’t be skipped. Read our introduction to statistics for management practitioners for a primer on the key statistical principles you need to know. When you read the results section focus on the following conceptual points:

• What questions are being tested?
• Do the results support the researcher’s predictions?

This information should be available in the results, and should not require statistical acumen to follow. 

Finally, the conclusion and discussion section of the paper should provide a more thorough interpretation of the results, as well as recommendations for future researchers and practitioners.

As you consume evidence-based research, look at the overall trends found across multiple studies, rather than focusing on the isolated findings of a single person. Work to also understand the theories that guide the scientific work.

• Why, according to the author, does an observed phenomenon occur?
• If a particular intervention works, how or why does it work?
• How strong is the presented evidence considering the applied methodology (e.g. single case study versus meta-analysis)?

The larger, theoretical picture is just as vital to understanding the literature as the individual findings are. An awareness of study limitations and flaws is also essential.

Science is an important source of knowledge and has strongly contributed to professionalize management and make work better. However, there are still many areas in management which lack a solid body of evidence as they have been newly discovered or empirical studies have not been conducted yet. In addition, the quality of the available scientific evidence also varies.

Empirical studies with small sample sizes lack the statistical power to draw reliable conclusions and can even be misleading. Academic publishing is not immune to biases as recent discussions about the shortcomings of traditional peer review processes and publication bias show (Dwan et al, 2013). How can you as a management practitioner deal with those flaws imminent in scientific evidence?

You can overcome these limitations of scientific evidence by considering additional sources of knowledge and select the best one for your specific case. In evidence-based management you should consider the following four sources of evidence whereas scientific research is one of them:

• Organizational data
• Professional expertise
• Stakeholder values and concerns
• Insights from scientific research

When you consider those four sources of evidence and select the best one you will improve your decision-making quality which will add up to an increased organizational performance over time.

• Evidence-based management involves using scientific evidence to make decisions
• Relying on scientific evidence can lead to managerial decisions that are less biased and more likely to succeed
• Evidence-based research is defined by peer review, documentation of data & methods, and a grounded interpretations of results
• Research databases such as PsychInfo, JSTOR, and Google Scholar can help a manager locate useful evidence
• Carefully read individual articles, but look at the overall trends in the scientific literature to determine which strategies are best

Scientific evidence has some limitations which makes it necessary to consider additional sources of evidence in certain circumstances

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Barends, E., Rousseau, D.M., & Briner, R.B. (2014).  Evidence-Based Management: The Basic Principles . Amsterdam: Center for Evidence-Based Management.

Bazerman, M.H. (2009). Judgment in Managerial Decision Making. Wiley, New York.

Dwan, K.M., Gamble, C., Williamson, P.R., & Kirkham, J. (2013). Systematic Review of the Empirical Evidence of Study Publication Bias and Outcome Reporting Bias — An Updated Review. PloS one .  https://doi.org/10.1371/journal.pone.0066844

Jefferson, T., Wager, E., & Davidoff, F. (2002). Measuring the quality of editorial peer review.  Jama , 287(21), 2786-2790.

Pfeffer, J., & Sutton, R. I. (2006). Evidence-based management.  Harvard Business Review , 84(1), 62.

Rousseau, D. M. (2006). Is there such a thing as “evidence-based management”?.  Academy of management review , 31(2), 256-269.

Rynes, S.L., Colbert, A.E., Brown, K.G. (2002). HR Professionals' beliefs about effective human resource practices: correspondence between research and practice. Human Resource Management, 41 (2), 149-174.

Sanders, K., van Riemsdijk, M., & Groen, B. (2008). The gap between research and practice: a replication study on the HR professionals’ beliefs about effective human resource practices.  The International Journal of Human Resource Management , 19(10), 1976-1988.

Spier, R. (2002). The history of the peer-review process.  Trends in Biotechnology , 20 (8), 357-358, ISSN.

Tschan, F., Semmer, N. K., Gurtner, A., Bizzari, L., Spychiger, M., Breuer, M., & Marsch, S. U. (2009). Explicit reasoning, confirmation bias, and illusory transactive memory: A simulation study of group medical decision making.  Small Group Research , 40(3), 271-300.

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Understanding science: Why social science matters in management and how to read scientific papers

Qualitative and Quantitative Approaches to Evidence-Based Management

Understanding science: How to evaluate the research quality of scientific studies?

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Challenges of using evidence in managerial decision-making of the primary health care system

• Marjan Hedayatipour 1 ,
• Sina Etemadi 1 ,
• Somayeh Noori Hekmat 1 &
• Alisadat Moosavi 2  

BMC Health Services Research volume  24 , Article number:  38 ( 2024 ) Cite this article

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Managerial Evidence-Based Decision-Making [EBDM] in the primary is a systematic approach that directs the decision-maker in a conscientious, explicit, and judicious utilization of reliable and best evidence based on the professional experiences and preferences of stakeholders and patients from various sources. This study aimed to investigate the challenges primary healthcare managers encounter while undertaking decision-making processes.

A systematic review was conducted in 2022 with the aim of identifying and collecting all qualitative articles pertaining to evidence-based decision-making in the primary healthcare system. To achieve this, a meticulous search was conducted using the relevant keywords, including primary health care and evidence-based decision making, as well as their corresponding synonyms, across the databases Web of Science, Scopus, and Pubmed. Importantly, there were no limitations imposed on the timeframe for the search. To carefully analyze and consolidate the findings of this systematic review, the meta-synthesis approach was employed.

A total of 22 articles were assessed in this systematic review study. The results revealed the main categories including evidence nature, EBDM barriers, utilizing evidence, decision-makers ability, organizational structure, evidence-based, EBDM support, communication for EBDM, evidence sides, EBDM skill development, public health promotion, and health system performance improvement.

The primary healthcare system is crucial in improving health outcomes and ensuring access to healthcare services for all individuals. This study explored the utilization of evidence-based EBDM within the primary healthcare system. We identified five key dimensions: causal, contextual, and intervening conditions, strategies, and consequences of EBDM as a core phenomenon. The findings will help policymakers and administrators comprehend the importance of evidence-based decision-making, ultimately leading to enhanced decision quality, community well-being, and efficiency within the healthcare system. EBDM entails considering the best reliable evidence, and incorporating community preferences while also exploiting the professional expertise and experiences of decision-makers. This systematic review has the potential to provide guidance for future reforms and enhance the quality of decision-making at the managerial level in primary healthcare.

Peer Review reports

Introduction

Healthcare organizations function within dynamic, competitive, and uncertain contexts that constantly transform, necessitating the need for adaptability in order to thrive and succeed in achieving their goals and mission [ 1 ]. In the realm of healthcare organizations, the processes of decision-making and management hold a paramount position due to their exceptional significance, thereby being capable of yielding consequential outcomes that possess the potential to greatly influence the direction and trajectory of these organizations [ 2 ]. If the managers of healthcare organizations apply the best evidence in their administration and decision-making processes, they have the potential to enhance the likelihood of the organization's triumph by executing efficacious choices [ 3 , 4 ].

Evidence-based decision-making [EBDM], is a methodical and systematic approach that directs the decision-maker in a conscientious, explicit, and judicious utilization of reliable and best evidence taking into consideration the preferences of stakeholders and patients from various sources. This approach entails a meticulous manner to enhance the probability of achieving favorable outcomes in high-quality health service delivery and patient satisfaction. The process involves the precise identification of the issue and the problem, followed by a comprehensive search for evidence. Subsequently, the evidence is collected and subjected to critical evaluation. Once this evaluation is complete, the decision-maker proceeds to carefully select and apply the evidence in the decision-making process. Finally, the results of the decisions made are evaluated to assess their effectiveness [ 5 , 6 , 7 , 8 ].

Provided that decisions are made within healthcare organizations without taking into account the most reliable and best evidence, it could result in detrimental outcomes. These adverse consequences encompass a lack of effectiveness, efficiency, and justice. This, in turn, leads to a decrease in productivity and overall inefficiency within society, as well as an escalation in healthcare costs. Moreover, it diminishes the quality of health services and overall performance within organizations, while also posing risks for adverse side effects. Additionally, it fosters conflicts of interest among stakeholders within health organizations, forfeiting opportunities to enhance the health of individuals within the community and ultimately eroding public trust in the healthcare system [ 9 ].

Evidence denotes the collection of information, data, or facts that a manager can utilize in order to arrive at an optimal decision. Evidence encompasses summaries of analyzed data and information pertaining to a specific domain, various forms of research specifically reviews, the professional perspectives of experts in the respective field, and, lastly, taking into consideration the values and preferences of patients and the other stakeholders [ 10 , 11 , 12 , 13 , 14 , 15 ].

Primary care centers serve as the first line of contact between the general population and the healthcare system. The responsibility of the primary care system in order to prevent, maintain, and enhance public health is of significant importance. Furthermore, considering the changes in the healthcare landscape and society, as well as the public's health service needs and expectations, it is imperative that experts in this field possess current information and evidence and utilize them to the maximum extent when making decisions. With EBDM at the forefront of healthcare, the health system can take effective measures to achieve the health-related goals of all community members [ 16 ].

Evidence-based decision-making is a professional process that relies on the best and most trustworthy evidence while considering expertise and taking into account patients' preferences and values [ 5 ]. It is a recommended approach to decision-making that utilizes theories, experience, knowledge, and information to improve managers' performance and decision-making [ 17 , 18 ]. By incorporating evidence into the management decisions of the primary healthcare system, we can anticipate improvements in public health and an increase in the quality of healthcare services. When managers utilize evidence in their decision-making, the outcomes become more reliable and of higher quality, allowing them to play a vital and influential role in guiding and leading different aspects of the primary healthcare system [ 16 ].

However, it is essential for healthcare managers to critically evaluate the evidence and ensure that it is based on sound scientific principles and valid data. Evidence-based decision-making concerning public health matters serves as a benchmark for best practices within the system, enabling managers to optimize patient care and health promotion, enhance the performance of healthcare organizations, and avoid resource wastage.

In recent years, there has been a growing body of research focused on the utilization of evidence within different facets of the healthcare system. Within this context, studies are about investigating the process of incorporating evidence into health system decision-making [ 3 , 7 , 9 , 19 , 20 ], evidence-based management practices, and the availability of evidence sources within hospitals [ 21 , 22 ], cross-sectional studies have also explored the identification and generation of evidence, sources of access to evidence, and the capacity for utilizing and evaluating evidence within the primary healthcare system [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. However, despite the production of evidence within the health system, particularly through research efforts, there are significant challenges in effectively knowledge translation, leveraging knowledge brokers, and utilizing evidence [ 12 , 31 , 32 , 33 ].

Given the importance of managerial decisions and their impact on health outcomes, as well as the significance of the primary healthcare system, it is crucial for managers and decision-makers within this field to base their decisions on the best available evidence. Nevertheless, they face obstacles in doing so. Therefore, this study was undertaken to investigate the challenges associated with the process of utilizing evidence in the management decisions of the primary healthcare system. Employing the grounded theory framework, this study examines the causal, contextual, and interventional conditions, strategies, and consequences of this process, drawing insights from studies conducted globally.

Systematic reviews are meticulously designed and conducted exploration of the existing literature. Their purpose is to comprehensively search, identify, evaluate, and consolidate all the pertinent and reliable research findings. The goal of a systematic review is to comprehensively locate and synthesize research that bears on a particular question using organized translucid and repeatable procedures at each step in the process [ 34 ]. The purpose of this systematic review and meta-synthesis was to ascertain the challenges encountered when incorporating evidence into managerial decision-making in PHC and strategies for its promotion in 2022.

Three databases were searched with no limitation of date, PubMed, Scopus, and Web of Science databases. A manual search in the Google Scholar search engine was used to complete and retrieve articles that were missed. The complete search process endeavor was conducted by an expert in library and information sciences specialist (AM). The search terms included two main concepts, "Evidence-Based Decision-Making" and "Primary Health Care". These phrases were adapted for use in each database. The search strategy was designed through the SPIDER tool. Since this systematic review was conducted using a qualitative research design, SPIDER Footnote 1 as an alternative search strategy tool for qualitative/mixed methods was used instead of the PICO Search Tool (suitable for quantitative studies) [ 35 ] (Table  1 ).

When formulating a search strategy, a search tool is used as the organizer framework to determine terms according to the primary concepts outlined in the search query, particularly in situations where it is unfeasible to include an experienced information specialist as a member of the review team. The PICO Tool places emphasis on the population, intervention, comparison, and outcomes of a (typically quantitative) article. It is commonly utilized to identify components of clinical evidence for systematic reviews in evidence-based medicine and is verified by the Cochrane Collaboration [ 36 ]. However, certain search terms such as "control group" and "intervention" lack relevance to qualitative research, which traditionally does not incorporate control groups or interventions, and as a result, may not adequately facilitate the finding of qualitative research [ 37 ]. The PICO Tool currently does not include terms related to qualitative research or specific qualitative designs. In practice, it is often modified to "PICOS" where the "S" represents the study design. This modification helps limit the number of irrelevant articles. In order to address this limitation, a new search tool called "SPIDER" was developed. The SPIDER Tool is designed specifically to identify relevant qualitative and mixed-method studies. The addition of the "design" and "research type" categories to the SPIDER Tool enhances its ability to identify qualitative articles while eliminating irrelevant PICO categories such as the "comparison" group [ 35 ]. Following the SPIDER parameters, the search strategy was as follows:

Inclusion criteria

Studies published in English

Qualitative studies including [but not limited to], phenomenology, grounded theory, ethnography, case studies, and thematic analysis studies addressing primary healthcare managers’ experiences, Opinions, and perceptions of EBDM.

Qualitative studies about the processes and nature of managerial evidence-based decision-making in the primary healthcare setting.

Overall, the review included studies that addressed the experiences, perceptions, challenges, consequences, and strategies to improve evidence-based decision-making of managers, policymakers, and primary healthcare researchers who had implemented and experienced the EBDM approach in any type of primary healthcare institution or organization in any environment at the global level.

Data extraction

Using the formulated search strategy, all articles on evidence-based management decision-making were retrieved without a specific time frame. Abstracts identified were imported into the Endnote. The duplicate articles were selected and removed. MH (primary reviewer) and SE (secondary reviewer) independently reviewed the abstracts for each paper using the eligibility criteria described above. Upon initial screening, the majority of the articles were excluded for the following reasons; not in English, and not about the managerial decision-making process in primary healthcare (PHC). Afterward, full-text articles were retrieved, MH and se independently reviewed the studies again and the following criteria were used to further exclude papers such as studies that did not use a qualitative methodology, did not about processes of managerial decision-making, or didn't discuss specifically about primary healthcare setting. The excluded studies were archived, along with the reason for exclusion. To ensure the reliability of the data collection process, MH and SE had several face-to-face discussions to reach a consensus on studies. Any disagreement between the two data collectors was resolved by a third researcher (SN).

Quality appraisal

The quality of the included studies was assessed by both reviewers independently using the critical appraisal skills program (CASP) checklist which assesses the risk of bias, and whether the study design, data collection, and analysis were appropriate for the study [ 38 ]. The assessment classified the quality of the studies at three strong, moderate, and weak levels. The eligible articles, i.e., strong and moderate articles, were included in the systematic review.

Data analysis and meta-synthesis

Given the qualitative nature of the data extracted from the studies, the meta-synthesis approach was used to analyze and consolidate the results of the systematic review. Compilation of qualitative findings is crucial for the advancement and progression of knowledge. Hence, the meta-synthesis of qualitative studies performs as a method that fosters the development of knowledge by amalgamating qualitative discoveries and phenomena that are of significance to the discipline [ 39 ]. Meta-synthesis entails the interpretation, integration, and inference of the process evaluation components derived from all the identified studies. Following thorough discussion and consensus among the reviewers, hypotheses are generated based on these findings [ 40 ].

The data were synthesized with an inductive approach. Data analysis was conducted using the grounded theory structure [ 41 , 42 ]. This approach is an initial exploration of the available research body in order to extract the full theoretical implication from a well-chosen set of published studies [ 43 ]. In the classic Grounded theory approach, the researcher starts the investigation with pure data with no available theoretical background or framework about the phenomena.

Grounded theory (GT) is a precise systematic inductive method to understanding the social process through analyzing qualitative data and permitting the analyst to propose important ideas and develop a substantive theory that is compatible and consistent with empirical observation. Therefore, GT has been adopted as a recommended methodology for qualitative studies' analysis, content comparison, and theory generation [ 44 ].

In the endeavor of formulating a substantive theory through the utilization of grounded theory (GT), Creswell (2012) proposes that the focus should be placed on the process rather than the consequences. In the realm of GT research, Strauss and Corbin (1998) [ 45 ]. Define a process as "a sequence of actions and interactions among people and events pertaining to a topic". Consequently, the analysis of managerial evidence-based decision-making in primary healthcare was approached as a social process, and it was conducted in accordance with three prescribed steps [ 41 , 46 ]: 1. Open coding—the establishment of preliminary categories of information regarding the phenomenon; 2. Axial coding—the identification of a core category and the determination of its relationships with the other identified categories; 3. Selective coding—the development of a theory aimed at elucidating the aforementioned relationships.

The data obtained from pertinent existing textual instances underwent a process of encoding through the application of a constant comparative analysis technique. The codes that emerged from this analysis were connected to overarching concepts, which were further organized into sub-categories and categories. These categories were subsequently classified into broader categories, enabling an exploration of the various casual conditions, core phenomena, intervening conditions, contexts, consequences, and strategies.

Moreover, the data and results related to EBDM within the PHC from the articles were extracted using a researcher-made checklist that determined the title, purpose, authors, place of publication, year of publication, journal, methodology, and results of the EBDM-related studies. Meta-synthesis was performed on the data collected from 22 articles using MAXQDA 2020 Software. Subsequently, a description of the managerial EBDM process in PHC is also presented.

Accordingly, a total of 22 articles were selected for the final review (Fig.  1 ).

Prisma flow diagram

Finally, 22 studies met the criteria for entering the review. Of all reviewed articles, 8 articles are in the United States [36 percent], 6 articles in Canada [27 percent], 2 articles in Australia [9 percent], 1 article from multiple countries including “Germany, Austria and Switzerland” [5 percent], 3 articles from the UK [14 percent], 1 article from Norway [5 percent] and 1 article from the Netherlands [5 percent] has been done (Fig.  2 ).

Frequency distribution of studies in different countries

Ultimately, 22 studies were reviewed. Codes, categories, and sub-categories were determined according to the statements extracted from the studies and related to the objectives (Table  2 ). Furthermore, the synthesis of results within the framework of the grounded theory model is illustrated (Fig.  3 ).

EBDM process Grounded Theory framework

Evidence nature

In general, out of the 22 final articles included in the study, some articles have directly addressed the evidence producers [ 47 , 48 , 49 , 50 , 51 , 52 ], the evidence users [ 48 , 49 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ], the Evidence Providers Skills [ 35 , 48 , 49 , 51 , 53 , 54 , 55 , 58 , 60 ], and Evidence Importance [ 50 , 53 , 54 , 56 , 59 , 61 , 62 , 63 ]. The evidence was examined from the perspective of both evidence producers and evidence users. The significant concept pertains to the request made by decision-makers in order to facilitate the process of EBDM via the demand for evidence. Therefore, it is imperative that researchers or knowledge brokers produce credible and beneficial evidence, enabling the making of high-quality decisions. Moreover, It has also been posited in the reviewed literature that the evidence could be obtained from various types of research methodologies (such as quantitative, qualitative, mixed methods, and specifically reviews, meta-synthesis, and meta-analysis) that could potentially be utilized by administrators and decision-makers in the primary healthcare setting.

EBDM barriers

Some reviewed articles also addressed the barriers that EBDM confront. These challenges included Sufficient Time to Produce Evidence [ 57 , 58 , 60 , 64 ], Sufficient Time to Use Evidence [ 49 , 54 , 58 , 61 , 62 , 65 ], Facilitating Access Importance [ 47 , 51 , 52 , 54 , 56 , 59 , 60 ], and Providing Electronic Access [ 35 , 51 , 54 , 56 , 57 , 59 , 61 , 66 ]. The issue under consideration is the existence of adequate time for producing, evaluating, and using evidence. Generally, the time required to conduct studies to produce evidence is relatively longer than the time available to decision-makers. The other imperative issue is access to evidence sources, especially electronic resources, or facilitating access to these resources. Facilitating the accessibility of diverse databases and developing appropriate tools to generate evidence, this act of facilitation transpires.

Utilizing evidence

Some articles addressed the knowledge translation importance [ 47 , 53 , 56 , 62 , 64 , 67 ], and the Knowledge Translation Process [ 35 , 47 , 54 , 59 , 60 , 61 , 63 ]. They stated that one of the ways to build EBDM capacity is the existence of an effective knowledge translation mechanism in the planning, decision-making, and functioning of public health organizations. Knowledge translation and transfer processes are significantly important to meet the expectations of decision-makers to use research evidence in public health decision-making and overcome individual, organizational, and contextual barriers to supporting, advancing, and sustaining EBDM. The concepts of knowledge broker's importance [ 47 , 58 , 61 ], and type of knowledge brokers [ 62 , 64 ] were discussed the importance of knowledge transfer, and how to implement it. The results indicated that the presence of knowledge brokers at work to complete a rapid review of evidence is a particular process. Knowledge mediation is a reliable process of translating organizational knowledge to support EBDM. The transfer and dissemination of knowledge through knowledge brokers facilitate knowledge transfer, promote decision-makers skills, and improve performance.

Decision-makers ability

Some articles addressed the cooperation and participation of EBDM in public health. This concept includes cooperation and participation importance [ 35 , 51 , 53 , 55 , 64 , 66 ], and types of cooperation and partnership [ 50 , 51 , 53 , 57 , 58 , 59 , 65 ]. In these studies, the interpretation of engagement and collaboration, notwithstanding the involvement of stakeholders, particularly patients and community members in the process of arriving at decisions, also signifies cooperation and participation on the side of the decision-maker as well as the researchers and knowledge brokers, with the aim of generating and utilizing evidence. It is imperative that such collaboration be undertaken to enhance the quality of decision-making. A few articles highlighted the comprehension and analysis skills of the decision-makers [ 58 , 67 ] and Type of evidence interpretation [ 60 ]. They discussed the dimensions of evidence understanding and analysis skills. If health organization managers lack statistical data analysis skills or interpret the evidence in a way that contradicts its nature, the EBDM process will turn into a challenging task.

Organizational structure

Some articles addressed the influence of political issues on the decision-making process [ 56 , 58 ] and discussed the variability and type of these effects on political issues [ 52 , 54 ]. The decision-making process is often affected by health policies, and in some cases, decision-makers have limited representation and authority in making decisions. However, some studies indicate the organizational culture importance [ 35 , 47 , 49 , 52 , 53 , 54 , 57 , 63 , 66 , 67 ], and create an organizational culture [ 47 , 53 , 57 , 59 , 61 , 66 ]. These articles highlighted the support of a talented, visionary, and strongly motivated senior health official as a requirement for EBDM to achieve its goals, activities, and success. Moreover, some other important concepts on this subject were intersectoral collaborations importance [ 52 , 56 , 58 , 67 ], intersectoral collaborations circumstance [ 35 , 62 , 66 ], commitments importance [ 56 , 65 ], type of commitments [ 53 ], promote EBDM Planning [ 49 , 55 ], and EBDM planning framework [ 49 , 51 ]. In an effort to effectively implement the EBDM process in the public health setting, the studies highlighted the require for interdisciplinary cooperation not only between health researchers but also between health researchers from several fields and community doctors and professionals from different fields. Without the dedication and commitment to employ this procedure and organize the framework for strategizing and planning, we cannot anticipate triumph and advancement in this particular approach.

Evidence-based

Articles reviewed indicated evidence types and definitions [ 54 , 63 ], source types [ 50 , 60 ], and source competency [ 53 , 60 , 62 ] pointed out that EBDM is a process in which multiple sources of information are consulted before making a decision regarding the provision of services. In this process, research evidence is integrated into the decision-making process to inform and guide public health policy and program planning. Studies emphasized the importance of receiving systematic reviews, executive summaries of research, and clear statements of implications for practice from health service researchers in order to facilitate the integration of research evidence into decision-making.

EBDM support

Four articles investigated the importance of support and how to create spiritual support EBDM process [ 47 , 61 , 65 , 66 ]. The provision of Spiritual Support, encouragement, and motivation to evidence producers and employees by leaders and decision-makers of the organization can serve as a significant catalyst in the process of evidence production and utilization. Additionally, some articles addressed financial and time resources importance [ 49 , 55 , 58 , 61 , 64 ], and Resource Generation [ 47 , 52 , 59 , 65 , 66 , 67 ]. They showed that one of the factors affecting evidence-based performance in the public health domain is having different budget sources. Furthermore, Workforce Development [ 52 , 56 , 59 , 66 ], and Provide/Use of Evidence Motivation [ 54 , 55 , 61 , 62 , 65 ] were considered effective dimensions. However, it is important to note that these dimensions can also be seen as shortcomings if they encounter difficulties, but can be employed as a means for enhancement to improve under different circumstances.

Communication and networking for EBDM

Some articles discussed organizational communication development [ 47 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 59 , 62 , 67 , 68 ] and creating internal and external networks [ 47 , 49 , 53 , 55 , 59 , 62 , 64 ]. One of the facilitating factors of EBDM in the primary healthcare system is networking to communicate and share information and evidence. To solicit evidence from researchers or, conversely, to furnish decision-makers with the evidence generated, it is advisable to enhance interpersonal and organizational communication, as well as communication with external entities, by implementing pragmatic methodologies and networking.

Evidence sides

The results of the reviewed studies demonstrated that the parameters of utilizing evidence encompass Require For Evidence [ 49 , 56 , 58 , 59 ], Produce The best Evidence [ 47 , 50 , 55 , 58 , 63 ], Leveraging Knowledge Brokers [ 56 , 59 , 64 ], and Supported By Grant Bodies [ 47 , 57 , 64 ]. strategies aimed at enhancing and promoting the utilization of evidence in managerial decision-making comprise establishing a mechanism and fostering a culture that emphasizes the importance of decision-makers appealing evidence. Moreover, this evidence ought to be generated in response to the demands of policymakers and managers, and should be presented in a manner that is comprehensible, highly pertinent, up-to-date, reliable, and applicable. Simultaneously, the involvement of knowledge brokers plays a crucial role in revitalizing and enhancing this process. Conversely, by considering valuable organizational credits and The growth of grant bodies for the EBDM, organizations are likely to exhibit greater adherence to this process.

EBDM skill development

Some studies acknowledged that EBDM skill development includes training for generation [ 48 , 49 , 51 , 52 , 53 , 54 , 55 , 57 , 59 , 65 , 66 ], evidence summary [ 53 , 60 , 63 , 66 ], evidence evaluating importance [ 49 , 53 , 55 , 61 ], and evidence evaluation capacity building [ 48 , 49 , 54 , 61 ]. In general, these articles highlighted education and training as one of the requirements, prerequisites, and facilitators of EBDM. likewise creating evidence summaries is one of the main strategies to facilitate decision-making and effective use of evidence. Whereas policymakers and managers utilize evidence, it is imperative to adopt a critical viewpoint and thoroughly assess the evidence in order to effectively ascertain and amalgamate the best evidence, subsequently enabling them to make an informed decision based on it.

Public health promotion

The results showed that the use of reliable evidence in decision-making will promote individual and public health Public Health Promotion [ 47 , 49 , 51 , 53 , 55 , 57 , 64 , 68 ]. The cause for this occurrence may be attributed to the advancements made in the realm of primary healthcare decision-making. Consequently, the implemented health programs, as well as the overall policies and services provided in this sector, have experienced enhancements.

Health system performance improvement

The articles discussed the health system performance improvement [ 47 , 49 , 51 , 53 , 55 , 57 , 64 , 68 ] as a general consequence. The review of the articles showed that one of the main outcomes of using EBDM in the primary healthcare system is to improve performance, effectiveness, efficiency, and quality of health service delivery.

EBDM is an approach to decision-making that relies on the most reliable, up-to-date, and best evidence. In the course of this approach, managers and decision-makers acquire and assess data and information from various sources, including scientific research, expert perspectives and opinions, and empirical data, as well as the preferences of stakeholders. EBDM endeavors to guarantee that decisions are grounded in factual and best information, as well as objective evaluations, rather than being influenced by subjective biases or personal convictions. This evidence-based approach enables decision-makers to make informed choices based on the best evidence, thus elevating the overall quality and effectiveness of decision-making processes.

To this end, this study aimed to identify the challenges of using evidence in the primary healthcare system as well as the ways to promote the use of evidence in managerial decision-making in this area. By reviewing 22 related studies, challenges, infrastructures, contextual conditions, strategies, and potential consequences were identified. The findings revealed the causal, contextual, and intervening conditions, and strategies needed for the establishment and promotion of EBDM, and identified the possible consequences.

Flexibility in producing evidence is very important because it makes it possible to face emerging issues [ 47 ]. Managers of health organizations can obtain evidence from various sources, including research, examination of the type of problem and its causal conditions, hospital information, and data, ethical and behavioral issues, management skills and experiences, and values and preferences of patients and beneficiaries, socio-political development programs, unique organizational and environmental characteristics, and analysis of the organization’s internal and external environment [ 47 , 48 , 49 , 50 , 51 , 52 , 54 , 55 , 56 , 57 , 58 , 67 ]. Most of the studies highlighted scientific and reliable research as the best source of evidence [ 50 , 53 , 54 , 56 , 59 , 61 , 62 , 63 ]. On the other hand, the language of the evidence should be such that the decision-makers can use it more easily and effectively [ 60 ]. Some studies showed the potential sources of evidence include organizational resources, managers’ experiences, research products, facts, information, environmental and external data, stakeholders, and social factors [ 69 , 70 , 71 , 72 , 73 , 74 ]. academic evidence, conferences, internal organizational feedback, internal and external standards, and organizational rules and regulations [ 74 ]. A group of studies also indicated that the internet, access to databases, organizational websites, and online library systems lead to the development of organizational infrastructure and improve access to evidence [ 75 , 76 , 77 ].

Making research findings more widely available to primary healthcare decision-makers is likely to be beneficial. Policymakers reported that summaries and systematic reviews were often difficult to access. In other words, the studies conducted are often not presented efficiently to inform the issues related to policies, programs, and strategies [ 78 , 79 , 80 ]. Creating a culture of EBDM, critical thinking in solving issues and problems, searching for evidence, and promoting creative behavior in the organization have a positive and significant effect on performance. This means that the multiplicity of ways to support, innovate, motivate, and encourage employees will promote evidence-based practices. The results of other studies were consistent with the findings of the present study [ 81 , 82 , 83 , 84 ].

More than half of the articles assessed in this systematic review highlighted the importance of organizational culture and its causal conditions [ 47 , 49 , 52 , 53 , 54 , 57 , 59 , 61 , 63 , 66 , 67 ]. Leaders of healthcare organizations can serve as endogenous catalysts for creating and promoting an EBDM culture. Besides, long-term and consistent engagement of senior leaders with staff in the effective use of evidence can enhance the prominence and durability of EBDM. Leaders must believe that good decisions must be based on evidence. Strong leadership can facilitate an organizational culture that is more supportive of change and more willing to challenge deep-rooted attitudes [ 85 , 86 , 87 ].

The data from the reviewed studies indicated that one of the methods and tools for promoting EBDM is continuous knowledge translation and transfer in the field of primary healthcare. Knowledge translation contributes to making evidence available to public health professionals and organizations as well as all levels of government to advance national public health priorities [ 47 , 53 , 54 , 56 , 60 , 61 , 62 , 63 , 66 , 68 ]. Knowledge translation is an effective strategy for strengthening the acceptance and application of research results. Knowledge translation is defined as the production, exchange, synthesis, and ethical application of knowledge in the complex system of interactions between researchers and users to accelerate the acquisition of benefits from research. Knowledge translation can also contribute to improving community health, promoting health services and outcomes, and strengthening the healthcare system [ 88 , 89 , 90 , 91 , 92 , 93 ].

Knowledge transfer as one of the effective components of the evidence-use process facilitates meeting the expectations of the use of research evidence in public health decisions. The availability of tools and the role of knowledge brokers to support the EBDM process are known to be very important as confirmed in other studies conducted in this field [ 47 , 58 , 61 , 62 , 64 ]. According to these studies, knowledge transfer is a conscious action related to actively transferring knowledge and creating insights, assessments, experiences, or skills through verbal or non-verbal tools that improve decision-making [ 94 , 95 , 96 , 97 , 98 , 99 ].

Creating opportunities for interaction between managers and researchers is key to promoting the use of research evidence in policy-making and decision-making. Policymakers often seek advice from researchers, but sometimes cannot find the expertise they need and tend to resort to people in their contact list [ 100 , 101 ]. On the other hand, researchers found that the participation of policymakers in their research projects is valuable, but they were often unsure of how to identify the right people. Moreover, many studies have recommended the creation of integrated evidence generation and consultation teams in the form of R&D centers in institutions operating in the primary healthcare system. Thus, with the cooperation and coordination of the members of the centers, up-to-date, reliable, and effective evidence is produced in the required and different areas and made available to the decision-makers at a suitable time or even before the occurrence of crises to prevent their consequences [ 47 , 53 , 55 , 64 ]. According to some studies, the public health workforce lacks adequate research skills and critical evaluation skills, and more formal and advanced training on EBDM concepts, tools, technologies, and applications is needed [ 49 , 102 , 103 ].

Evidence-based public health, described as the integration of science-based interventions with community preferences to improve population health, has been widely expanded using community protection guidelines. Identifying evidence-based practices in public health contributes to creating an underlying and operational environment that supports and facilitates evidence-based public health [ 104 ]. Formulating policies and making effective health and evidence-based decisions; responding to public health emergencies; selecting, implementing, and evaluating cost-effective interventions; and the allocation of human and financial resources in health organizations, despite the agreement that decisions should be rational and based on data and evidence, also lead to the improvement of health outcomes [ 67 ]. The use of evidence in decisions and performance leads to the improvement of the quality of decisions and time and cost management. The effectiveness of EBDM can be improved by promoting it in public health departments and health sector decision-makers. Researchers also receive effective results and feedback to produce evidence [ 64 , 79 ]. This study was conducted with some shortcomings, including the unavailability of the full text of all the articles in the systematic review, the multiplicity of databases in the countries, the differences in different health systems in various countries, and the inaccessibility of some databases in Iran. However, by synthesizing the data extracted from studies on EBDM in the primary healthcare system, the present study presented significant evidence to improve the EBDM process.

The primary healthcare system is essential as it serves as individuals' first point of contact, providing comprehensive and accessible care, and promoting early intervention, disease prevention, and community health promotion. It plays a crucial role in improving health outcomes and ensuring equitable access to healthcare services for all individuals. High-quality decision-making in this area holds significant importance. This study investigation scrutinized the utilization of Evidence-Based Decision-Making [EBDM] by administrators within the primary healthcare system on a global scale. This analysis encompassed an evaluation of five key aspects pertaining to the core phenomenon of evidence-based decision-making. These five dimensions encompass causal, contextual, intervening, strategies, and consequences; utilization of these dimensions offers us an all-encompassing perspective on EBDM. The analysis of the studies included in this systematic review will help policymakers, administrators, and decision-makers in the realm of primary healthcare to Understand the nature and significance of using evidence in their decision-making process. This will enable them to employ the best information and efficacious approaches to leverage data and attain desirable outcomes, which would in turn enhance the quality of decision-making, foster community well-being, and optimize the efficacy of the healthcare system. EBDM is a systematic approach that entails utilizing the best available evidence when making determinations in the realm of public health. This approach leads to community involvement and takes into account community preferences, while also exploiting the professional expertise and experiences of decision-makers. Overall, the perception generated through this research has the potential to enhance the quality of the decision-making process within the primary healthcare system and serve as a roadmap for future reforms and promotion.

Availability of data and materials

The data in the study is comprised of previous research articles. A full list of articles is available from the corresponding author.

Sample, Phenomenon of Interest, Design, Evaluation, and Research Type.

Abbreviations

Evidence-Based Decision-Making

Primary Healthcare

Grounded theory

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Patient, Intervention, Comparison, Outcome

Sample, Phenomenon of Interest, Design, Evaluation, and Research Type

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The bibliographic report of the studies included in the systematic review.

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Hedayatipour, M., Etemadi, S., Hekmat, S.N. et al. Challenges of using evidence in managerial decision-making of the primary health care system. BMC Health Serv Res 24 , 38 (2024). https://doi.org/10.1186/s12913-023-10409-7

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Evidence-based management: from theory to practice in health care

Affiliation.

• 1 Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, Birmingham B15 2RT, United Kingdom. [email protected]
• PMID: 11565163
• PMCID: PMC2751196
• DOI: 10.1111/1468-0009.00214

The rise of evidence-based clinical practice in health care has caused some people to start questioning how health care managers and policymakers make decisions, and what role evidence plays in the process. Though managers and policymakers have been quick to encourage clinicians to adopt an evidence-based approach, they have been slower to apply the same ideas to their own practice. Yet, there is evidence that the same problems (of the underuse of effective interventions and the overuse of ineffective ones) are as widespread in health care management as they are in clinical practice. Because there are important differences between the culture, research base, and decision-making processes of clinicians and managers, the ideas of evidence-based practice, while relevant, need to be translated for management rather than simply transferred. The experience of the Center for Health Management Research (CHMR) is used to explore how to bring managers and researchers together and promote the use of evidence in managerial decision-making. However, health care funders, health care organizations, research funders, and academic centers need wider and more concerted action to promote the development of evidence-based managerial practice.

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Original research

Evidence-based practice models and frameworks in the healthcare setting: a scoping review, jarrod dusin.

1 Department of Evidence Based Practice, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA

2 Therapeutic Science, The University of Kansas Medical Center, Kansas City, Kansas, USA

Andrea Melanson

Lisa mische-lawson, associated data.

bmjopen-2022-071188supp001.pdf

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No data are available.

The aim of this scoping review was to identify and review current evidence-based practice (EBP) models and frameworks. Specifically, how EBP models and frameworks used in healthcare settings align with the original model of (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change, along with patient values and preferences and clinical skills.

A Scoping review.

Included sources and articles

Published articles were identified through searches within electronic databases (MEDLINE, EMBASE, Scopus) from January 1990 to April 2022. The English language EBP models and frameworks included in the review all included the five main steps of EBP. Excluded were models and frameworks focused on one domain or strategy (eg, frameworks focused on applying findings).

Of the 20 097 articles found by our search, 19 models and frameworks met our inclusion criteria. The results showed a diverse collection of models and frameworks. Many models and frameworks were well developed and widely used, with supporting validation and updates. Some models and frameworks provided many tools and contextual instruction, while others provided only general process instruction. The models and frameworks reviewed demonstrated that the user must possess EBP expertise and knowledge for the step of assessing evidence. The models and frameworks varied greatly in the level of instruction to assess the evidence. Only seven models and frameworks integrated patient values and preferences into their processes.

Many EBP models and frameworks currently exist that provide diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models and frameworks. Also, the issues of EBP expertise and knowledge to assess evidence must be considered when choosing a model or framework.

STRENGTHS AND LIMITATIONS OF THIS STUDY

• Currently, no comprehensive review exists of evidence-based practice (EBP) models and frameworks.
• Well-developed models and frameworks may have been excluded for not including all five steps of original model for EBP.
• This review did not measure the quality of the models and frameworks based on validated studies.

Introduction

Evidence-based practice (EBP) grew from evidence-based medicine (EBM) to provide a process to review, translate and implement research with practice to improve patient care, treatment and outcomes. Guyatt 1 coined the term EBM in the early 1990s. Over the last 25 years, the field of EBM has continued to evolve and is now a cornerstone of healthcare and a core competency for all medical professionals. 2 3 At first, the term EBM was used only in medicine. However, the term EBP now applies to the principles of other health professions. This expansion of the concept of EBM increases its complexity. 4 The term EBP is used for this paper because it is universal across professions.

Early in the development of EBP, Sackett 5 created an innovative five-step model. This foundational medical model provided a concise overview of the process of EBP. The five steps are (1) asking the question, (2) acquiring the best evidence, (3) appraising the evidence, (4) applying the findings to clinical practice and (5) evaluating the outcomes of change. Other critical components of Sackett’s model are considering patient value and preferences and clinical skills with the best available evidence. 5 The influence of this model has led to its integration and adaption into every field of healthcare. Historically, the foundation of EBP has focused on asking the question, acquiring the literature and appraising the evidence but has had difficulty integrating evidence into practice. 6 Although the five steps appear simple, each area includes a vast number of ways to review the literature (eg, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Newcastle-Ottawa Scale) and entire fields of study, such as implementation science, a field dedicated to implementing EBP. 7 8 Implementation science can be traced to the 1960s with Everett Rogers’ Diffusion of Innovation Theory and has grown alongside EBP over the last 25 years. 7 9

One way to manage the complexity of EBP in healthcare is by developing EBP models and frameworks that establish strategies to determine resource needs, identify barriers and facilitators, and guide processes. 10 EBP models and frameworks provide insight into the complexity of transforming evidence into clinical practice. 11 They also allow organisations to determine readiness, willingness and potential outcomes for a hospital system. 12 EBP can differ from implementation science, as EBP models include all five of Sackett’s steps of EBP, while the non-process models of implementation science typically focus on the final two steps. 5 10 There are published scoping reviews of implementation science, 13 however, no comprehensive review of EBP models and frameworks currently exists. Although there is overlap of EBP, implementation science and knowledge translation models and frameworks 10 14 the purpose of the scoping review was to explore how EBP models and frameworks used in healthcare settings align with the original EBP five-step model.

A scoping review synthesises findings across various study types and provides a broad overview of the selected topic. 15 The Arksey and O’Malley method and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) procedures guided this review (see online supplemental PRISMA-ScR checklist ). 15 16 The primary author established the research question and inclusion and exclusion criteria before conducting the review. An a priori protocol was not pre-registered. One research question guided the review: Which EBP models and frameworks align with Sackett’s original model?

Supplementary data

Eligibility criteria.

To be included in the review, English language published EBP models and frameworks needed to include the five main steps of EBP (asking the question, acquiring the best evidence, appraising the evidence, applying the findings to clinical practice and assessing the outcomes of change) based on Sackett’s model. 5 If the models or frameworks involved identifying problems or measured readiness for change, the criteria of ‘asking the question’ was met. Exclusions included models or frameworks focused on one domain or strategy (eg, frameworks focused on applying findings). Also, non-peer-reviewed abstracts, letters, editorials, opinion articles, and dissertations were excluded.

Search and selection

To identify potential studies, a medical librarian searched the databases from January 1990 to April 2022 in MEDLINE, EMBASE and Scopus in collaboration with the primary author. The search was limited to 1990 because the term EBP was coined in the early 90s. The search strategy employed the following keywords: ‘Evidence-Based Practice’ OR ‘evidence based medicine’ OR ‘evidence-based medicine’ OR ‘evidence based nursing’ OR ‘evidence-based nursing’ OR ‘evidence based practice’ OR ‘evidence-based practice’ OR ‘evidence based medicine’ OR ‘evidence-based medicine’ OR ‘evidence based nursing’ OR ‘evidence-based nursing’ OR ‘evidence based practice’ OR ‘evidence-based practice’ AND ‘Hospitals’ OR ‘Hospital Medicine’ OR ‘Nursing’ OR ‘Advanced Practice Nursing’ OR ‘Academic Medical Centers’ OR ‘healthcare’ OR ‘hospital’ OR ‘healthcare’ OR ‘hospital’ AND ‘Models, Organizational’ OR ‘Models, Nursing’ OR ‘framework’ OR ‘theory’ OR ‘theories’ OR ‘model’ OR ‘framework’ OR ‘theory’ OR ‘theories’ OR ‘model’. Additionally, reference lists in publications included for full-text review were screened to identify eligible models and frameworks (see online supplemental appendix A for searches).

Selection of sources of evidence

Two authors (JD and AM) independently screened titles and abstracts and selected studies for potential inclusion in the study, applying the predefined inclusion and exclusion criteria. Both authors then read the full texts of these articles to assess eligibility for final inclusion. Disagreement between the authors regarding eligibility was resolved by consensus between the three authors (JD, AM and LM-L). During the selection process, many models and frameworks were found more than once. Once a model or framework article was identified, the seminal article was reviewed for inclusion. If models or frameworks had been changed or updated since the publication of their seminal article, the most current iteration published was reviewed for inclusion. Once a model or framework was identified and verified for inclusion, all other articles listing the model or framework were excluded. This scoping review intended to identify model or framework aligned with Sackett’s model; therefore, analysing every article that used the included model or framework was unnecessary (see online supplemental appendix B for tracking form).

Data extraction and analysis

Data were collected on the following study characteristics: (1) authors, (2) publication year, (3) model or framework and (4) area(s) of focus in reference to Sackett’s five-step model. After initial selection, models and frameworks were analysed for key features and alignment to the five-step EBP process. A data analysis form was developed to map detailed information (see online supplemental appendix C for full data capture form). Data analysis focused on identifying (1) the general themes of the model or frameworks, and (2) any knowledge gaps. Data extraction and analysis were done by the primary author (JD) and verified by one other author (AM). 15

Patient and public involvement

Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

The search identified 6523 potentially relevant references (see figure 1 ). Following a review of the titles and abstracts, the primary author completed a more detailed screening of 37 full papers. From these, 19 models and frameworks were included. Table 1 summarises the 19 models and frameworks. Of the 19 models and frameworks assessed and mapped, 15 had broad target audiences, including healthcare or public health organisations or health systems. Only five models and frameworks included a target audience of individual clinicians (eg, physicians and nurses). 17–22

Retrieval and selection process.

Models and frameworks organised by integration of patient preferences and values

EBP, evidence-based practice.

Asking the question

All 19 models and frameworks included a process for asking questions. Most focused on identifying problems that needed to be addressed on an organisational or hospital level. Five used the PICO (population, intervention, comparator, outcome) format to ask specific questions related to patient care. 19–25

Acquiring the evidence

The models and frameworks gave basic instructions on acquiring literature, such as ‘conduct systematic search’ or ‘acquire resource’. 20 Four recommended sources from previously generated evidence, such as guidelines and systematic reviews. 6 21 22 26 Although most models and frameworks did not provide specifics, others suggested this work be done through EBP mentors/experts. 20 21 25 27 Seven models included qualitative evidence in the use of evidence, 6 19 21 24 27–29 while only four models considered the use of patient preference and values as evidence. 21 22 24 27 Six models recommended internal data be used in acquiring information. 17 20–22 24 27

Assessing the evidence

The models and frameworks varied greatly in the level of instruction provided in assessing the best evidence. All provided a general overview in assessing and grading the evidence. Four recommended this work be done by EBP mentors and experts. 20 25 27 30 Seven models developed specific tools to be used to assess the levels of evidence. 6 17 21 22 24 25 27

Applying the evidence

The application of evidence also varied greatly for the different models and frameworks. Seven models recommended pilot programmes to implement change. 6 21–25 31 Five recommended the use of EBP mentors and experts to assist in the implementation of evidence and quality improvement as a strategy of the models and frameworks. 20 24 25 27 Thirteen models and frameworks discussed patient values and preferences, 6 17–19 21–27 31 32 but only seven incorporated this topic into the model or framework, 21–27 and only five included tools and instructions. 21–25 Twelve of the 20 models discussed using clinical skill, but specifics of how this was incorporated was lacking in models and frameworks. 6 17–19 21–27 31

Evaluating the outcomes of change

Evaluation varied among the models and frameworks, but most involved using implementation outcome measures to determine the project’s success. Five models and frameworks provide tools and in-depth instruction for evaluation. 21 22 24–26 Monash Partners Learning Health Systems provided detailed instruction on using internal institutional data to determine success of application. 26 This framework uses internal and external data along with evidence in decision making as a benchmark for successful implementation.

EBP models and frameworks provide a process for transforming evidence into clinical practice and allow organisations to determine readiness and willingness for change in a complex hospital system. 12 The large number of models and frameworks complicates the process by confusing what the best tool is for healthcare organisations. This review examined many models and frameworks and assessed the characteristics and gaps that can better assist healthcare organisations to determine the right tool for themselves. This review identified 19 EBP models and frameworks that included the five main steps of EBP as described by Sackett. 5 The results showed that the themes of the models and frameworks are as diverse as the models and frameworks themselves. Some are well developed and widely used, with supporting validation and updates. 21 22 24 27 One such model, the Iowa EBP model, has received over 3900 requests for permission to use it and has been updated from its initial development and publication. 24 Other models provided tools and contextual instruction such as the Johns Hopkin’s model which includes a large number of supporting tools for developing PICOs, instructions for grading literature and project implementation. 17 21 22 24 27 By contrast, the ACE Star model and the An Evidence Implementation Model for Public Health Systems only provide high level overview and general instructions compared with other models and frameworks. 19 29 33

Gaps in the evidence

A consistent finding in research of clinician experience with EBP is the lack of expertise that is needed to assess the literature. 24 34 35 The models and frameworks reviewed demonstrated that the user must possess the knowledge and related skills for this step in the process. The models and frameworks varied greatly in the level of instruction to assess the evidence. Most provided a general overview in assessing and grading the evidence, though a few recommended that this work be done by EBP mentors and experts. 20 25 27 ARCC, JBI and Johns Hopkins provided robust tools and resources that would require administrative time and financial support. 21 22 27 Some models and frameworks offered vital resources or pointed to other resources for assessing evidence, 24 but most did not. While a few used mentors and experts to assist with assessing the literature, a majority did not address this persistent issue.

Sackett’s five-step model included another important consideration when implementing EBP: patient values and preferences. One criticism of EBP is that it ignores patient values and preferences. 36 Over half of the models and frameworks reported the need to include patient values and preferences, but the tools, instruction or resources for including them were limited. The ARCC model integrates patient preferences and values into the model, but it is up to the EBP mentor to accomplish this task. 37 There are many tools for assessing evidence, but few models and frameworks provide this level of guidance for incorporating patient preference and values. The inclusion of patient and family values and preferences can be misunderstood, insincere, and even tokenistic but without it there is reduced chance of success of implementation of EBP. 38 39

Strengths and limitations

Similar to other well-designed scoping reviews, the strengths of this review include a rigorous search conducted by a skilled librarian, literature evaluation by more than one person, and the utilisation of an established methodological framework (PRISMA-ScR). 14 15 Additionally, utilising the EBP five-step models as a point of alignment allows for a more comprehensive breakdown and established reference points for the reviewed models and frameworks. While scoping reviews have been completed on implementation science and knowledge translation models and framework, to our knowledge, this is the first scoping review of EBP models and frameworks. 13 14 Limitations of the study include that well-developed models and frameworks may have been excluded for not including all five steps. 40 For example, the Promoting Action on Research Implementation in Health Services (PARIHS) framework is a well-developed and validated implementation framework but did not include all five steps of an EBP model. 40 Also, some models and frameworks have been studied and validated over many years. It was beyond the scope of the review to measure the quality of the models and frameworks based on these other validated studies.

Implications and future research

Healthcare organisations can support EBP by choosing a model or framework that best suits their environment and providing clear guidance for implementing the best evidence. Some organisations may find the best fit with the ARCC and the Clinical Scholars Model because of the emphasis on mentors or the Johns Hopkins model for its tools for grading the level of evidence. 21 25 27 In contrast, other organisations may find the Iowa model useful with its feedback loops throughout its process. 24

Another implication of this study is the opportunity to better define and develop robust tools for patient and family values and preferences within EBP models and frameworks. Patient experiences are complex and require thorough exploration, so it is not overlooked, which is often the case. 39 41 The utilisation of EBP models and frameworks provide an opportunity to explore this area and provide the resources and understanding that are often lacking. 38 Though varying, models such as the Iowa Model, JBI and Johns Hopkins developed tools to incorporate patient and family values and preferences, but a majority of the models and frameworks did not. 21 22 24 An opportunity exists to create broad tools that can incorporate patient and family values and preferences into EBP to a similar extent as many of the models and frameworks used for developing tools for literature assessment and implementation. 21–25

Future research should consider appraising the quality and use of the different EBP models and frameworks to determine success. Additionally, greater clarification on what is considered patient and family values and preferences and how they can be integrated into the different models and frameworks is needed.

This scoping review of 19 models and frameworks shows considerable variation regarding how the EBP models and frameworks integrate the five steps of EBP. Most of the included models and frameworks provided a narrow description of the steps needed to assess and implement EBP, while a few provided robust instruction and tools. The reviewed models and frameworks provided diverse instructions on the best way to use EBP. However, the inclusion of patient values and preferences needs to be better integrated into EBP models. Also, the issues of EBP expertise to assess evidence must be considered when selecting a model or framework.

Supplementary Material

Acknowledgments.

We thank Keri Swaggart for completing the database searches and the Medical Writing Center at Children's Mercy Kansas City for editing this manuscript.

Contributors: All authors have read and approved the final manuscript. JD conceptualised the study design, screened the articles for eligibility, extracted data from included studies and contributed to the writing and revision of the manuscript. LM-L conceptualised the study design, provided critical feedback on the manuscript and revised the manuscript. AM screened the articles for eligibility, extracted data from the studies, provided critical feedback on the manuscript and revised the manuscript. JD is the guarantor of this work.

Funding: The article processing charges related to the publication of this article were supported by The University of Kansas (KU) One University Open Access Author Fund sponsored jointly by the KU Provost, KU Vice Chancellor for Research, and KUMC Vice Chancellor for Research and managed jointly by the Libraries at the Medical Center and KU - Lawrence

Disclaimer: No funding agencies had input into the content of this manuscript.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

Ethics statements, patient consent for publication.

Not applicable.