A Framework of Evidence-Based Decision-Making in Health System Management: Applying Best-Fit Framework Synthesis

Abstract Background: Scientific evidence is the basis for improving public health; decision-making without sufficient attention to evidence may lead to unpleasant consequences. In recent years, efforts have been made to create more comprehensive guidelines for evidence-based decision-making (EBDM), thus the purpose of the present study was developing a framework for EBDM to make the best decisions concerning to scare resources and too many needs. Methods: The present basic-applied research was a secondary study carried out using qualitative research method in 2019. A Systematic Scoping Review (SSR) was done for the comprehensive review of the existing published studies in this area. This method, according to Arksey and O’Malley approach, consists of five main stages and one optional stage. Results: Based on the SSR, 3751 studies from 7 databases were found, and due to the full-text screening of the studies, 30 final studies were selected for extracting the components and steps of EBDM in Health System Management (HSM). After collecting, synthesizing, and categorizing key information, the framework of EBDM in HSM is developed in the form of four general scopes of inquiring, inspecting, implementing and integrating, which includes 10 main steps and 56 sub-steps. Conclusions: The present framework tries to present a sequential systematic map to achieve evidence-based decision and policy making specially for under developed and developing countries which mostly suffer from applying update and applied evidences in their decision-making process. At the same time, it seems that the present framework tries to synthesize and integrate the fragmented elements of the other models and in this way can be tested by developed countries to improve their EBDM cycle.

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A Framework of Evidence-Based Decision-Making in Health System Management: A Best-Fit Framework Synthesis and a Scoping Review

10.21203/rs.3.rs-24295/v2 ◽

2020 ◽

Author(s):

Tahereh Shafaghat ◽

Peivand Bastani ◽

Mohammad Hasan Imani Nasab ◽

Mohammad Amin Bahrami ◽

Zahra Kavosi ◽

...

Keyword(s):

Decision Making ◽

Health System ◽

Scoping Review ◽

Developed Countries ◽

System Management ◽

Decision Making Process ◽

Evidence Based ◽

Public Health Decision ◽

Best Fit ◽

Evidence Based Decision Making

Abstract Background: Scientific evidence is the basis for improving public health; decision-making without sufficient attention to evidence may lead to unpleasant consequences. Despite efforts to create comprehensive guidelines and models for evidence-based decision-making (EBDM), there isn`t any to make the best decisions concerning scarce resources and unlimited needs. The present study aimed to develop a comprehensive applied framework for EBDM. Methods: This was a meta-synthesis including two phases of a Scoping Review (SR) and a Best-Fit Framework (BFF) synthesis conducted in 2019. A scoping review was done for the comprehensive review of the existing published studies in this area. The six-stage approach of Arksey and O’Malley was applied. Six main databases including PUBMED, Scopus, Web of Science, Science Direct, EMBASE, and ProQuest were searched using related keywords. Data were extracted and analyzed via thematic analysis. Results of the scoping review were then synthesized to achieve the best-fit framework applying Carroll et al (2013) approach. Results: Based on the SR, 3751 studies were found, and due to the full-text screening of the studies, 30 final articles were selected for extracting the components and steps of EBDM in Health System Management (HSM). After collecting, synthesizing, and categorizing key information, the framework of EBDM in HSM was developed in the form of four general scopes. These comprised inquiring, inspecting, implementing, and integrating, which included 10 main steps and 56 sub-steps. Conclusions: The present framework provided a comprehensive guideline that can be well adapted for implementing EBDM in health systems and related organizations especially in underdeveloped and developing countries where there is usually a lag in updating and applying evidence in their decision-making process. In addition, this framework by providing a complete, well-detailed, and sequential process can be tested in the organizational decision-making process by developed countries to improve their EBDM cycle.

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Classifying scientific evidence as the basis for evidence-based decision making: is strength of evidence absolute?

Evidence-Based Endodontics ◽

10.1186/s41121-016-0005-7 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Eyal Rosen ◽

Igor Tsesis

Keyword(s):

Decision Making ◽

Scientific Evidence ◽

Evidence Based ◽

Strength Of Evidence ◽

Evidence Based Decision Making

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Strengthening evidence-based decision-making: is it possible without improving health system stewardship?

Health Policy and Planning ◽

10.1093/heapol/czr072 ◽

2011 ◽

Vol 27 (6) ◽

pp. 499-504 ◽

Cited By ~ 17

Author(s):

R. Majdzadeh ◽

B. Yazdizadeh ◽

S. Nedjat ◽

J. Gholami ◽

S. Ahghari

Keyword(s):

Decision Making ◽

Health System ◽

Evidence Based ◽

Evidence Based Decision Making

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Improving Health Empowerment and Evidence-Based Decision-Making using Collective Intelligence and Self-management Health System

Proceedings of the 5th International Conference on Technological Ecosystems for Enhancing Multiculturality - TEEM 2017 ◽

10.1145/3144826.3149548 ◽

2017 ◽

Author(s):

Pedro Pérez-Alcántara ◽

Manuel Herrera-Usagre

Keyword(s):

Decision Making ◽

Health System ◽

Collective Intelligence ◽

Self Management ◽

Evidence Based ◽

Health Empowerment ◽

Evidence Based Decision Making

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Evidence-Based Decision-Making for a Public Health Emergency in China: Easier Said Than Done

The American Review of Public Administration ◽

10.1177/0275074020942410 ◽

2020 ◽

Vol 50 (6-7) ◽

pp. 720-724

Author(s):

Liwei Zhang ◽

Kelin Chen ◽

Ji Zhao

Keyword(s):

Public Health ◽

Decision Making ◽

Local Government ◽

Local Governments ◽

Scientific Evidence ◽

Behavioral Pattern ◽

Public Health Emergency ◽

Evidence Based ◽

Governance Reform ◽

Evidence Based Decision Making

This article aims to argue that evidence-based decision-making for a public health emergency is “easier said than done” reflected on COVID-19 response in China. For the local government, the behavioral pattern is prone to blame-avoiding instead of making decision following scientific evidence and experts’ advice. However, such behavior is not based on completely subjective judgment but a rational choice for the local government. Some consequences associated with China’s response to COVID-19 reveals an inflexible administrative system. Therefore, China’s governance reform should focus on empowering local governments with more flexibility and resilience, which enables local governments to make independent and scientific decisions in an emergency.

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Towards an evidence-based decision making healthcare system management: Modelling patient pathways to improve clinical outcomes

Decision Support Systems ◽

10.1016/j.dss.2012.12.039 ◽

2013 ◽

Vol 55 (1) ◽

pp. 117-125 ◽

Cited By ~ 19

Author(s):

Shola Adeyemi ◽

Eren Demir ◽

Thierry Chaussalet

Keyword(s):

Decision Making ◽

Clinical Outcomes ◽

Healthcare System ◽

System Management ◽

Evidence Based ◽

Patient Pathways ◽

Evidence Based Decision Making

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Using health data for decision-making at each level of the health system to achieve universal health coverage in Ethiopia: the case of an immunization programme in a low-resource setting

Health Research Policy and Systems ◽

10.1186/s12961-021-00694-1 ◽

2021 ◽

Vol 19 (S2) ◽

Author(s):

Binyam Tilahun ◽

Alemayehu Teklu ◽

Arielle Mancuso ◽

Berhanu F. Endehabtu ◽

Kassahun D. Gashu ◽

...

Keyword(s):

Decision Making ◽

Health System ◽

Performance Monitoring ◽

Data Use ◽

Routine Data ◽

Health Data ◽

Evidence Based ◽

Local Data ◽

Evidence Based Decision Making ◽

Different Levels

Abstract Background For evidence-based decision-making, there is a need for quality, timely, relevant and accessible information at each level of the health system. Limited use of local data at each level of the health system is reported to be a main challenge for evidence-based decision-making in low- and middle-income countries. Although evidence is available on the timeliness and quality of local data, we know little about how it is used for decision-making at different levels of the health system. Therefore, this study aimed to assess the level of data use and its effect on data quality and shared accountability at different levels of the health system. Methods An implementation science study was conducted using key informants and document reviews between January and September 2017. A total of 21 key informants were selected from community representatives, data producers, data users and decision-makers from the community to the regional level. Reviewed documents include facility reports, district reports, zonal reports and feedback in supervision from the district. Thematic content analysis was performed for the qualitative data. Results Respondents reported that routine data use for routine decision-making was low. All health facilities and health offices have a performance monitoring team, but these were not always functional. Awareness gaps, lack of motivating incentives, irregularity of supportive supervision, lack of community engagement in health report verification as well as poor technical capacity of health professionals were found to be the major barriers to data use. The study also revealed that there are no institutional or national-level regulations or policies on the accountability mechanisms related to health data. The community-level Health Development Army programme was found to be a strong community engagement approach that can be leveraged for data verification at the source of community data. Conclusion The culture of using routine data for decision-making at the local level was found to be low. Strengthening the capacity of health workers and performance monitoring teams, introducing incentive mechanisms for data use, engaging the community in data verification and introducing accountability mechanisms for health data are essential to improve data use and quality.

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Evidence-based decision-making: practical issues in the appraisal of evidence to inform policy and practice

Australian Health Review ◽

10.1071/ah09778 ◽

2010 ◽

Vol 34 (4) ◽

pp. 435 ◽

Cited By ~ 5

Author(s):

Bronwyn J. Carter

Keyword(s):

Public Health ◽

Systematic Review ◽

Decision Making ◽

Critical Appraisal ◽

Public Health Education ◽

Evidence Based ◽

National Guidelines ◽

Policy And Practice ◽

Public Health Decision ◽

Evidence Based Decision Making

Objective. To highlight the differences between a systematic review of the literature and a systematic review of the best available evidence; to discuss practical issues in the appraisal of evidence to inform public health policy and practice; and to make recommendations for next steps in the development of evidence-based decision making in public health. Data sources and selection. Literature and other sources were reviewed including the subject reading list, recommended texts and websites for the La Trobe University postgraduate subject Evidence Based Public Health Practice 2007 and other relevant sources identified. Data extraction and synthesis. Relevant opinions were extracted to summarise debate in relation to definitions of evidence, usefulness of systematic reviews, tools for critical appraisal and other practical issues in the translation of evidence into practice. Conclusions. Evidence relevant to decisions regarding public health policy and practice may include evidence from the literature including experimental and observational studies as well as other sources, including policies and opinions of stakeholders. Further development of skills and approaches to the critical appraisal of evidence are required. Recommendations include: mapping of Australian competencies to public health education; development of national guidelines to inform the appraisal of evidence for public health decision making; and promotion of leadership and education in evidence-based approaches, discussion and debate in relation to definitions of evidence, and public health research that generates the best possible evidence. What is known about the topic? Systematic reviews are a well recognised tool for the critical appraisal of evidence to inform decision making. There is a lack of agreement about what constitutes valid evidence for inclusion in such reviews and many policy makers have no training or qualifications in the use of systematised approaches to the critical appraisal of evidence from a range of sources to inform decisions. Approaches to critical appraisal of evidence and skills in appraisal of evidence and evidence-based decision making require further development. What does this paper add? This paper reviews current opinions on what constitutes valid evidence and discusses important differences between a systematic review of the literature as distinct from a systematic review of available evidence. The desirable approach is recognised as the utilisation of the best available evidence from a range of sources to inform decision making, including evidence from observational studies including qualitative data, as well as contextual and colloquial evidence. This paper calls for: mapping of Australian competencies to public health education; development of national guidelines to inform the appraisal of evidence for public health decision making; and the promotion of leadership and education in evidence-based approaches, discussion and debate in relation to definitions of evidence and the promotion of public health research that generates the best possible evidence. What are the implications for practitioners? This paper calls upon practitioners to further develop skills in critical appraisal of evidence from a range of sources to inform policy and practice, and to foster collaborative partnerships between researchers, policy makers, educators, managers and clinicians.

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