Evidence-based management of Caribbean health systems: barriers and opportunities

2017 ◽  
Vol 22 (2) ◽  
pp. 104-117 ◽  
Author(s):  
Damian Eisenghower Greaves
Keyword(s):  
Decision Making ◽  
Health Systems ◽  
Policy Development ◽  
Small Island ◽  
Evidence Based ◽  
Senior Managers ◽  
Content Type ◽  
Island States ◽  
Leadership Strategy ◽  
Barriers And Opportunities

Purpose The purpose of this paper is to explore and assess barriers and opportunities for evidence-based management (EBMgt) and decision-making in healthcare systems of the small island developing states (SIDSs) of English-speaking Caribbean. Design/methodology/approach The study utilized grounded theory to collect and analyze data on experiences and perceptions of 20 senior managers/leaders from seven Ministries of health in the region. It used semi-structured, in-depth interviews comprising open-ended questions. Data analysis comprised open, focused and theoretical coding. Findings EBMgt and decision-making is not a prominent approach taken by top officials of health systems because of internal and external barriers to its use. Indeed the absence of a culture of decision-making based on evidence pervades the public services of Caribbean island states. Notwithstanding, there are opportunities for meaningful application of this management/leadership strategy. Originality/value To the author’s knowledge, this is the first assessment of the application of EBMgt to health systems of SIDSs of the Caribbean. This paper is concerned with the approach to decision-making in health systems across island states and lends support to the use of evidence in decision-making and policy development. It provides useful direction for policy makers, and senior managers/leaders of these systems.

scholarly journals The challenge of bringing evidence in decision-making for public health emergencies: can preparedness reach out to HTA?

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C E Chronaki ◽  
A Miglietta
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Policy Development ◽  
Digital Health ◽  
Resource Planning ◽  
Public Health Emergency ◽  
Evidence Based ◽  
Public Health Emergencies ◽  
The Impact ◽  
Evidence Based Decision Making

Abstract Evidence-based decision-making is central to public health. Implementing evidence-informed actions is most challenging during a public health emergency as in an epidemic, when time is limited, scientific uncertainties and political pressures tend to be high, and reliable data is typically lacking. The process of including data for preparedness and training for evidence-based decision making in public health emergencies is not systematic and is complicated by many barriers as the absence of common digital tools and approaches for resource planning and update of response plans. Health Technology Assessment (HTA) is used with the aim to improve the quality and efficiency of public health interventions and to make healthcare systems more sustainable. Many of today's public health crises are also cross-border, and countries need to collaborate in a systematic and standardized way in order to enhance interoperability to share data and to plan coordinated response. Digital health tools have an important role to play in this setting, facilitating use of knowledge about the population that can potentially affected by the crisis within and across regional and national borders. To strengthen the impact of scientific evidence on decision-making for public health emergency preparedness and response, it is necessary to better define and align mechanisms through which interdisciplinary evidence feeds into decision-making processes during public health emergencies and the context in which these mechanisms operate. Activities and policy development in the HTA network could inform this process. The objective of this presentation is to identify barriers for evidence-based decision making during public health emergencies and discuss how standardization in digital health and HTA processes may help overcome these barriers leading to more effective coordinated and evidence-based public health emergency response.

A multiple criteria group decision-making approach for the assessment of small and medium-sized enterprise competitiveness

2019 ◽  
Vol 57 (2) ◽  
pp. 480-500 ◽  
Author(s):  
Joana M. Gonçalves ◽  
Fernando A.F. Ferreira ◽  
João J.M. Ferreira ◽  
Luís M.C. Farinha
Keyword(s):  
Decision Making ◽  
Evaluation System ◽  
Cognitive Mapping ◽  
Assessment System ◽  
Senior Managers ◽  
Content Type ◽  
Face To Face ◽  
Decision Making Processes ◽  
Constructivist Epistemology ◽  
Study Context

PurposeSmall- and medium-sized enterprises (SMEs) have become increasingly important in national and international markets because they contribute to the development of local and national economies. SMEs often face serious challenges when competing with multinational companies. The purpose of this paper is to develop a method for assessing SMEs’ competitiveness.Design/methodology/approachBased on a constructivist epistemology, this study makes an integrated use of cognitive mapping and the measuring attractiveness by a categorical-based evaluation technique (MACBETH). To this end, face-to-face sessions were conducted with a panel of entrepreneurs and senior managers who deal with the challenges of maintaining SME competitiveness every day. The proposed assessment system was tested and validated by the panel members.FindingsThe methodological processes adopted in this study provide promising results for decision makers seeking to identify the most competitive SMEs. Specifically, the results emphasize, among other points, the importance of innovation and the human dimension to gaining competitive advantages.Research limitations/implicationsThe evaluation system developed in this study is extremely versatile and confirms the usefulness of integrating cognitive mapping and MACBETH to facilitate evaluations of SME competitiveness. However, due to its idiosyncratic and process-oriented nature, generalizations need to be done with caution.Practical implicationsThe proposed method can be valuable to researchers seeking to develop mechanisms for evaluating SMEs’ entrepreneurial performance and include specialized know-how and sensemaking in organizational decision-making processes.Originality/valueThe integrated use of cognitive maps and MACBETH contributes to a better understanding of how to assess SMEs’ competitiveness. No prior work reporting the use of this dual methodology in this study context has been found.

Studer Group® ' s evidence-based leadership initiatives

2015 ◽  
Vol 29 (6) ◽  
pp. 684-700 ◽  
Author(s):  
Kristin A. Schuller ◽  
Bita A. Kash ◽  
Larry D. Gamm
Keyword(s):  
Health Systems ◽  
Success Factors ◽  
Driving Forces ◽  
Qualitative Content Analysis ◽  
Critical Factor ◽  
Comparative Case Study ◽  
Successful Implementation ◽  
Evidence Based ◽  
Content Type ◽  
Systems Leadership

Purpose – The purpose of this paper is to analyze the implementation of an organizational change initiative – Studer Group®’s Evidence-Based Leadership (EBL) – in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative. Design/methodology/approach – This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes. Findings – Three themes associated with success and sustainability of EBL emerged at both health systems: leadership; culture; and organizational processes. The theme most frequently identified for both success and sustainability of EBL was culture. In contrast, there was a significant decline in salience of the leadership theme as attention shifts from success in implementation of EBL to sustaining EBL long term. Within the culture theme, accountability, and buy-in were most often cited by interviewees as success factors, while sense of accountability, buy-in, and communication were the most reported factors for sustainability. Originality/value – Cultural factors, such as accountability, staff support, and communication are driving forces of success and sustainability of EBL across both health systems. Leadership, a critical factor in several stages of implementation, appears to be less salient as among factors identified as important to longer term sustainability of EBL.

Anti-virus policies may hurt democracy in eastern EU

2020 ◽  
Keyword(s):  
Decision Making ◽  
Big Data ◽  
Health Systems ◽  
Ad Hoc ◽  
Content Type ◽  
East European ◽  
Excessive Demand ◽  
University Level ◽  
East And West ◽  
Back Education

Subject Eastern EU’s handling of COVID-19 pandemic. Significance Central-East European (CEE) authorities are more reactive than proactive on COVID-19 management and have devised an ad hoc patchwork of measures; all are relying on 'stay-at-home' strategies to curb excessive demand on health systems. Politically, COVID-19 is not creating new attitudes but amplifying existing ones. It offers national-populists a fertile environment for centralising decision-making further and adopting measures incompatible with normal democratic standards. Impacts The next EU budget may take into account the latest revelation of less affluent members’ structural weaknesses. However, EU solidarity will be further stretched, creating new tensions between east and west. Although working online is less advanced in most CEE countries, appreciation of and investment in big data and technology will increase. Lockdowns will hold back education, with teachers, even at university level, underprepared to deliver courses remotely.

Three perspectives on evidence-based management: rank, fit, variety

2018 ◽  
Vol 56 (10) ◽  
pp. 2085-2100 ◽  
Author(s):  
Peter F. Martelli ◽  
Tuna Cem Hayirli
Keyword(s):  
Decision Making ◽  
Science And Technology Studies ◽  
Management Decision ◽  
Evidence Based ◽  
Managerial Decision ◽  
Content Type ◽  
Rigorous Research ◽  
Central Notion ◽  
Management Decision Making ◽  
Cybernetic Theory

Purpose The debate on evidence-based management (EBMgt) has reached an impasse. The persistence of meaningful critiques highlights challenges embedded in the current frameworks. The field needs to consider new conceptual paths that appreciate these critiques, but move beyond them. The paper aims to discuss this issue. Design/methodology/approach This paper unpacks the concept of finding the “best available evidence,” which remains a central notion across definitions of EBMgt. For each element, it considers relevant theory and offers recommendations, concluding with a discussion of “bestness” as interpreted across three key dynamics – rank, fit, and variety. Findings The paper reinforces that EBMgt is a social technology, and draws on cybernetic theory to argue that the “best” evidence is produced not by rank or fit, but by variety. Through variety, EBMgt more readily captures the contextual, political, and relational aspects embedded in management decision making. Research limitations/implications While systematic reviews and empirical barriers remain important, more rigorous research evidence and larger catalogues of contingency factors are themselves insufficient to solve underlying sociopolitical concerns. Likewise, current critiques could benefit from theoretical bridges that not only reinforce learning and sensemaking in real organizations, but also build on the spirit of the project and progress made towards better managerial decision making. Originality/value The distinctive contribution of this paper is to offer a new lens on EBMgt drawing from cybernetic theory and science and technology studies. By proposing the theoretical frame of variety, it offers potential to resolve the impasse between those for and against EBMgt.

Decision-making experiences of public library CEOs

2015 ◽  
Vol 36 (8/9) ◽  
pp. 644-652 ◽  
Author(s):  
Cheryl Stenstrom
Keyword(s):  
Decision Making ◽  
Information Science ◽  
Public Library ◽  
Library And Information Science ◽  
Evidence Based ◽  
Interpersonal Influence ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Content Type ◽  
The Relationship

Purpose – The purpose of this paper is to explore and describe the decision-making practices of public library managers in the context of interpersonal influence and evidence-based information sources, and to investigate the relationship between models of evidence-based practice and interpersonal influence in the decision-making process of public library managers. Design/methodology/approach – Data were collected through short audio blog posts participants made about their everyday decisions and coded considering the facets of three existing evidence-based library and information practice (EBLIP) models as well as the facets of interpersonal influence. Findings – The findings show that public library CEOs decision-making behaviours reflect the use of a variety of practices from analytical to intuitive as is expected of managers in any sector; however, a stronger reliance on gathering objective information may be present than in other sectors. Seeking multiple sources of information and a tendency towards rationalism may indicate a more sophisticated approach to decision making, but be less indicative of the practices employed more broadly. A possible outcome of these tendencies may result in discordance with external partners and collaborators. Practical implications – The findings from this study may inform the work of associations, library and information science (LIS) educators, and library managers in developing strategic directions and instructional strategies within their organisations. It is also the first study to jointly examine models of interpersonal influence and evidence-based decision-making practices in any field. Originality/value – While the study of the decision-making practices of various groups is growing, little previous research has been conducted with public library managers, and none has been undertaken in Canada.

scholarly journals Shipping managers’ information behavior during a pandemic crisis

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kelly Gerakoudi-Ventouri
Keyword(s):  
Decision Making ◽  
Market Competition ◽  
Information Behavior ◽  
Digital Information ◽  
Capital Investments ◽  
Information Uncertainty ◽  
Senior Managers ◽  
Content Type ◽  
Information Behaviors ◽  
Daunting Challenge

Purpose A significant body of literature suggests that shipping companies operate in an extremely volatile and risky environment, relying on the effective use of information to remain competitive. However, decision-making in this market is demanding because of the high uncertainty, market competition and significant capital investments. Moreover, the rapid spread of COVID-19 renders information uncertainty a daunting challenge for companies engaged in global trade. Hence, this study aims to explore the information behavior of managers in a time of crisis seems compelling. Design/methodology/approach This study provides novel insights into the information behavior of senior managers by adopting a qualitative approach. Forty-nine semi-structured face-to-face interviews with individuals from Hellenic shipping companies were conducted. Moreover, this study explores the extant theory qualitatively, using the grounded theory methodology and shows that an unprecedented event (pandemic crisis) can redefine the information behavior of managers. Findings This study highlights the importance of information in decision-making. Moreover, the results show that, during a pandemic, managers resort to alternative information sources, adopt collaborative information behaviors and take advantage of digital technology. Originality/value There is limited research in exploring the information behavior of managers in times of pandemics. This research underscores the fact that during a crisis, managers seek information from digital information resources and decision-making assumes a more decentralized form. This study concludes with a discussion of the theoretical and practical implications of these findings.

scholarly journals Adoption of the concept of person-centred care into discourse in Europe: a systematic literature review

2021 ◽  
Vol 35 (9) ◽  
pp. 265-280 ◽  
Author(s):  
Kristina Rosengren ◽  
Petra Brannefors ◽  
Eric Carlstrom
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Literature Review ◽  
Systematic Approach ◽  
Grey Literature ◽  
Quality Of Healthcare ◽  
Healthcare Systems ◽  
Evidence Based ◽  
Content Type ◽  
Healthcare Settings

PurposeThis study aims to describe how person-centred care, as a concept, has been adopted into discourse in 23 European countries in relation to their healthcare systems (Beveridge, Bismarck, out of pocket).Design/methodology/approachA literature review inspired by the SPICE model, using both scientific studies (CINHAL, Medline, Scopus) and grey literature (Google), was conducted. A total of 1,194 documents from CINHAL (n = 139), Medline (n = 245), Scopus (n = 493) and Google (n = 317) were analysed for content and scope of person-centred care in each country. Countries were grouped based on healthcare systems.FindingsResults from descriptive statistics (percentage, range) revealed that person-centred care was most common in the United Kingdom (n = 481, 40.3%), Sweden (n = 231, 19.3%), the Netherlands (n = 80, 6.7%), Northern Ireland (n = 79, 6.6%) and Norway (n = 61, 5.1%) compared with Poland (0.6%), Hungary (0.5%), Greece (0.4%), Latvia (0.4%) and Serbia (0%). Based on healthcare systems, seven out of ten countries with the Beveridge model used person-centred care backed by scientific literature (n = 999), as opposed to the Bismarck model, which was mostly supported by grey literature (n = 190).Practical implicationsAdoption of the concept of person-centred care into discourse requires a systematic approach at the national (politicians), regional (guidelines) and local (specific healthcare settings) levels visualised by decision-making to establish a well-integrated phenomenon in Europe.Social implicationsEvidence-based knowledge as well as national regulations regarding person-centred care are important tools to motivate the adoption of person-centred care in clinical practice. This could be expressed by decision-making at the macro (law, mission) level, which guides the meso (policies) and micro (routines) levels to adopt the scope and content of person-centred care in clinical practice. However, healthcare systems (Beveridge, Bismarck and out-of-pocket) have different structures and missions owing to ethical approaches. The quality of healthcare supported by evidence-based knowledge enables the establishment of a well-integrated phenomenon in European healthcare.Originality/valueOur findings clarify those countries using the Beveridge healthcare model rank higher on accepting/adopting the concept of person-centered care in discourse. To adopt the concept of person-centred care in discourse requires a systematic approach at all levels in the organisation—from the national (politicians) and regional (guideline) to the local (specific healthcare settings) levels of healthcare.

scholarly journals Independent Reviewing Officers’ and social workers’ perceptions of children’s participation in Children in Care Reviews

2019 ◽  
Vol 14 (3) ◽  
pp. 162-173
Author(s):  
Clive Diaz ◽  
Hayley Pert ◽  
Nigel Patrick Thomas
Keyword(s):  
Decision Making ◽  
Young People ◽  
Social Workers ◽  
Local Authority ◽  
Senior Managers ◽  
High Turnover ◽  
Content Type ◽  
Children’S Participation ◽  
Children's Participation ◽  
Children In Care

Purpose The research reported here forms part of a study of children’s participation in children in care reviews and decision making in one local authority in England. The purpose of this paper is to outline the views of 11 social workers and 8 Independent Reviewing Officers (IROs) and explores their perceptions of children’s participation in reviews. The paper considers the barriers to young people participating meaningfully in decision making and how practice could be improved in this vital area so that children’s voices are more clearly heard and when possible acted upon by professionals. Design/methodology/approach The data reported here derive from a qualitative cross-sectional study in one English local authority. The entire study involved interviewing children in care, IROs, social workers and senior managers about young people’s participation in their reviews. Findings from the interviews with young people and senior managers have been reported elsewhere (Diaz and Aylward, 2018; Diaz et al., 2018); this paper focusses on the interviews with social workers and IROs. Specifically, the authors were interested in gaining insight into their views about the following research questions: To what degree do children and young people meaningfully participate in reviews? What are the barriers to participation? What can be done to improve children and young people’s participation in reviews? Findings During this process seven themes were identified, five of which concerned barriers to effective participation and two which concerned factors that appeared to support effective participation. These are summarised below and explained further in the following sections. Barriers to effective participation: social workers and IROs’ high caseloads and ensuing time pressures; high turnover of social workers and inexperienced staff; lack of understanding and training of professionals in participation; children and young people’s negative experiences of reviews and consequent reticence in taking part; and structure and process of the review not being child-centred. Factors which assist participation: quality of the relationship between the child and professionals; and the child or young person chairing their own review meeting. Research limitations/implications Although these findings reflect practice in one local authority, their consistency with other research in this area suggests that they are applicable more widely. Practical implications The practice of children chairing their own reviews was pioneered by The Children’s Society in North West England in the 1990s (Welsby, 1996), and has more recently been implemented with some success by IROs in Gloucestershire (see Thomas, 2015, p. 47). A key recommendation from this study would be for research to explore how this practice could be developed and embedded more widely. Previous research has noted the tension between the review being viewed as an administrative process and as a vehicle of participation (Pert et al., 2014). This study highlighted practitioner reservations about young people chairing their own reviews, but it also gave examples of how this had been done successfully and how it could improve children’s participation in decision making. At the very least, it is essential that young people play a role in deciding where the review is going to take place, when it will take place, who is going to be invited and what will be included on the agenda. Social implications The paper highlights that in this Local Authority caseloads for social workers were very high and this, combined with a high turnover of staff and an inexperienced workforce, meant that children in care struggled to have a consistent social worker. This often meant that young people were not able to build up a positive working relationship with their social worker, which negatively impacted on their ability to play a meaningful role in decision making. Originality/value There have been very few recent studies that have considered professionals’ perspectives of children’s participation in key meetings and decision making, so that this provides a timely and worthwhile contribution to this important area of work.

scholarly journals Climate change adaptation in the management of public buildings: an Indonesian context

2019 ◽  
Vol 37 (2) ◽  
pp. 140-162
Author(s):  
Jose Arif Lukito ◽  
Connie Susilawati ◽  
Ashantha Goonetilleke
Keyword(s):  
Climate Change ◽  
Decision Making ◽  
Community Engagement ◽  
Climate Change Adaptation ◽  
Asset Management ◽  
Policy Development ◽  
Change Leadership ◽  
Public Buildings ◽  
Data Set ◽  
Content Type

PurposeThe purpose of this paper is to provide a strategy to integrate climate change adaptation (CCA) in public asset management (PAM) in Indonesia. This paper focusses on public buildings as part of a public asset.Design/methodology/approachAs an archipelagic country, Indonesia is very vulnerable to sea-level rise as a result of climate change. The outcomes of a qualitative analysis of interviews with relevant stakeholders were used for the development of the CCA framework in an Indonesian context.FindingsThe study identified that the integration of CCA in PAM in Indonesia requires the incorporation of nine key elements. These are as follows: recognition of climate change; risk management and insurance schemes for assets; integrated asset management and planning; asset use and knowledge; reliable, accessible and understandable data set on climate change; leadership, government commitment and incentives; involvement of research and private entities; community engagement; and coordination of relevant agencies.Research limitations/implicationsThis paper informed only the key elements required on the development of framework which integrate CCA in PAM.Practical implicationsThe integration of CCA to a PAM framework will support the development of policies and procedures for better-informed decisions.Social implicationsThe framework increases opportunities for stakeholders and community engagement in policy development and decision making in relation to CCA for public assets.Originality/valueThis paper synthesises CCA and PAM using knowledge from the three levels of governments in Australia and Indonesia. CCA and PAM groups work separately in Indonesia and integration will reduce climate change risks and improve decision making in PAM.

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