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 Leadership in Health Services
Use of evidence-based management in healthcare administration decision-making
Ruiling Guo, Steven D. Berkshire, Lawrence V. Fulton, Patrick M. Hermanson,
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LHS
30,3
Use of evidence-based
management in healthcare
administration decision-making
330 Ruiling Guo
Health Care Administration, Kasiska School of Health Professions,
Received 28 July 2016
Revised 17 October 2016
Idaho State University, Pocatello, Idaho, USA
11 December 2016
Accepted 28 December 2016 Steven D. Berkshire
Department of Health Administration, College of Health Professions,
Central Michigan University, Mount Pleasant, Michigan, USA
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Lawrence V. Fulton
Department of Health Organization Management, Rawls College of Business,
Texas Tech University, Lubbock, Texas, USA, and
Patrick M. Hermanson
Health Care Administration, Kasiska School of Health Professions,
Idaho State University, Pocatello, Idaho, USA

Abstract
Purpose – The purpose of this paper is to examine whether healthcare leaders use evidence-based
management (EBMgt) when facing major decisions and what types of evidence healthcare administrators
consult during their decision-making. This study also intends to identify any relationship that might exist
among adoption of EBMgt in healthcare management, attitudes towards EBMgt, demographic characteristics
and organizational characteristics.
Design/methodology/approach – A cross-sectional study was conducted among US healthcare leaders.
Spearman’s correlation and logistic regression were performed using the Statistical Package for the Social
Sciences (SPSS) 23.0.
Findings – One hundred and fifty-four healthcare leaders completed the survey. The study results
indicated that 90 per cent of the participants self-reported having used an EBMgt approach for
decision-making. Professional experiences (87 per cent), organizational data (84 per cent) and
stakeholders’ values (63 per cent) were the top three types of evidence consulted daily and weekly for
decision-making. Case study (75 per cent) and scientific research findings (75 per cent) were the top two
types of evidence consulted monthly or less than once a month. An exploratory, stepwise logistic
regression model correctly classified 75.3 per cent of all observations for a dichotomous “use of EBMgt”
response variable using three independent variables: attitude towards EBMgt, number of employees in
the organization and the job position. Spearman’s correlation indicated statistically significant
relationships between healthcare leaders’ use of EBMgt and healthcare organization bed size (rs ⫽ 0.217,
n ⫽ 152, p ⬍ 0.01), attitude towards EBMgt (rs ⫽ 0.517, n ⫽ 152, p ⬍ 0.01), and the number of organization
employees (rs ⫽ 0.195, n ⫽ 152, p ⫽ 0.016).
Originality/value – This study generated new research findings on the practice of EBMgt in US healthcare
administration decision-making.
Leadership in Health Services
Vol. 30 No. 3, 2017 Keywords Decision-making, Healthcare organizations, Evidence-based management,
pp. 330-342
© Emerald Publishing Limited Healthcare management, Health leaders, Healthcare administrators
1751-1879
DOI 10.1108/LHS-07-2016-0033 Paper type Research paper
 Background Management
Introduction to the concept of evidence-based management (EBMgt) began in the late 1990s in healthcare
(Stewart, 1998). EBMgt is originally derived from evidence-based medicine (EBM). EBMgt is
defined as making decisions about the management of employees, teams or organizations
administration
through the conscientious, explicit and judicious use of best available scientific evidence in
conjunction with professional experiential evidence, organizational data and stakeholder
concerns ([Center for Evidence-based Management CEBM], 2014).
Evidence based management is considered the best professional practice in management. 331
However, a literature review suggests that it has not been widely adopted by healthcare
administrators in their professional practice in the USA (Kovner and Rundall, 2006; Arndt
and Bigelow, 2009; Damore, 2006; Hofmann, 2010). The literature review also reveals that the
adoption of EBMgt has been slow among healthcare administrators in the USA (Walshe and
Rundall, 2001), while clinical healthcare professionals have embraced evidence-based
practice in healthcare (Amin et al., 2007; Bartelt et al., 2011; Heiwe et al., 2011; Jette et al., 2003;
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Shuval et al., 2007).

Kovner and other scholars stated that EBMgt would improve the competence of
decision-makers and their motivation to use more scientific methods in healthcare
management decision-making (Kovner and Rundall, 2006; Pfeffer and Sutton, 2006).
Healthcare administrators are health leaders whose decisions have a significant impact on
the effectiveness of delivering quality patient care and on the success of healthcare
organizations. Patient safety, quality of care and access, widespread demands for reducing
the cost of care and value-based purchasing, all require healthcare administrators to take an
evidence-based approach when making decisions. It is important for healthcare
administrators to adopt an EBMgt approach to their administration and management.
Health administrators are accountable for both their patients and their healthcare
organizations. However, few studies have been published to examine whether healthcare
leaders use an evidence-based approach for management decision-making.
Evidence is an important component of practicing EBMgt. Best available research
evidence should be used for management decision-making, in conjunction with professional
experience, organizational data and stakeholders’ values and concerns (CEBM, 2014).
According to the EBM pyramid (Figure 1), different levels of evidence can be utilized by
physicians and other healthcare professionals for their clinical decision-making. Figure 1
depicts the levels of evidence from the bottom to the top. The pyramid suggests that the level
of evidence is increased as it goes up. Based on the principles of EBM, randomized controlled
trial (RCT) studies, systematic reviews and meta-analyses are considered the higher levels of

Meta-analysis

Systemac reviews

RCTs

Cohort studies

Case-control studies

Case series/Case reports

Background informaon/Expert opinion Figure 1.

Evidence-based
Note: RCTs refers to randomized controlled trials medicine pyramid
 LHS evidence because they present much more reliable information with less bias than personal
30,3 opinions. However, personal professional experience is often used by healthcare leaders
when making management decisions. A different perception on level of evidence exists
between physicians and healthcare administrators. Scholars discussed what types of
evidence should be used in decision-making (Young, 2002; Liang et al., 2011). A literature
review suggests that few studies have been conducted to identify what evidence levels
332 healthcare administrators use for decision-making and how often they consult scientific
research evidence when making decisions in healthcare organizations.
The purpose of this exploratory study is to examine whether healthcare leaders use
EBMgt when facing major decisions and what types of evidence healthcare administrators
consult during their decision-making. This study also intends to identify any relationships
that might exist among adoption of EBMgt in healthcare management, attitudes towards
EBMgt, demographic characteristics and organizational characteristics.
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Research questions
The specific research questions to be investigated in this study are as follows:
RQ1. Do healthcare administrators use an EBMgt approach when making major
decisions in healthcare organizations?
RQ2. What types of evidence do they consult for decision-making in healthcare
management?
RQ3. Is there any relationship between healthcare leaders’ attitude toward EBMgt and
their use of EBMgt?
RQ4. Do healthcare administrators’ demographic characteristics (e.g. age, level of
education, years of management experience in healthcare) influence their use of
EBMgt?
RQ5. Is there any association between the size of healthcare organizations (e.g. hospital
bed size, number of employees) and healthcare administrators’ use of EBMgt?

Methods
Study design
A cross-sectional study was conducted using a two-stage cluster sampling to examine
whether healthcare leaders use EBMgt when making decisions and what evidence they use
for management decision-making. The American Hospital Association (AHA) divides 50
states into nine regions. The AHA Guide listed a total of 6,400 health care organizations,
including the names of each of the hospitals and the names of chief executive officers as
contact persons of their respective health care organizations. At the first stage of cluster
sampling, the investigators randomly selected 14 states out of the nine regions (50 states) in
the USA. At the second stage of cluster sampling, 1,210 health care organizations were
randomly selected out of the 14 states.

Study population and sampling

The study population was senior healthcare leaders in US healthcare organizations, who
were chief executive officers (CEOs) and acting leaders of healthcare organizations with
management experience in healthcare settings. Using a two-stage cluster sampling, 1,210
potential participants were randomly selected.
 Instrument Management
Participants were asked to respond to survey items related to personal demographic in healthcare
information, healthcare organizational information, use of EBMgt, types of evidence for
decision-making, frequency of evidence used, and attitude toward EBMgt. The content
administration
validity of the instrument was established based on literature reviews and assessed by
subject matter experts in healthcare administration. A pilot test of the instrument was
conducted among 20 healthcare administrators across the USA. The instrument was further
modified as a result of the pilot test. Cronbach’s alpha analysis was performed and the 333
analysis results showed that the coefficients for “type of evidence” was 0.84 and “attitude
toward EBMgt” was 0.89. Both correlation coefficients were greater than 0.80, indicating
acceptable internal consistency reliability.

Data collection
An online survey was developed using Qualtrics, a web-based software. Hard copies of the
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questionnaire, with a cover letter and a return envelope, were mailed to 1,210 randomly
selected participants. In addition, an online survey was sent out through these health care
leaders’ email accounts identified via the internet or their organizations. All of the
participants were informed of the purpose of the study and that their participation in the
survey was completely voluntary. They were allowed to freely withdraw at any time during
the survey and to abstain from answering any questions with which they felt uncomfortable.
A reminder was sent out to non-respondents via email five times and post cards were mailed
twice to non-respondents.
Survey data were collected via online and mail and then kept confidential in the principal
researcher’s office cabinet. Prior to the administration of the survey, an institutional review
board approval for this study was obtained.

Data analysis
Prior to data analysis, all survey data were screened for missing values, outliers and
normality (where appropriate). Observations with missing values (2 of 154) were not
included in the inferential analysis. Initially, Spearman’s correlation for ordinal variables
was performed using IBM® SPSS® 23.0, while Cramer’s V was used to investigate nominal
versus nominal and nominal versus ordinal relationships to evaluate relationships among
‘use of EBMgt’ and participant demographic characteristics, healthcare organization
characteristics and attitudes toward EBMgt. Exploratory, logistic regression was performed
on a dichotomous version of “use of EBMgt” with variables associated with demographics,
hospital characteristics and attitude towards the use of EBMgt.

Results
General information on participants
A total of 154 participants completed the survey, for a 12.7 per cent response rate. Out of 154,
86 per cent (133/154) of the participants were chief executive officers; 12 per cent (18/154)
were chief administrative officers; and 2 per cent (3/154) were other senior healthcare leaders
acting as a contact person of a healthcare organization. Table I shows the distribution of
participant job titles. Concerning gender, 77 per cent (119/154) were males and 23 per cent
(35/154) were females. Regarding age, 45 per cent (69/154) of the participants were between
the ages of 50-59 years; 37 per cent (57/154) were 60 years old or over; and 18 per cent (28/154)
were between the ages of 30-49 years.
Concerning level of education, 8 per cent (12/154) had a bachelor’s degree, 80 per cent
(124/154) had a master’s degree and 12 per cent (18/154) had a doctoral degree (e.g. PhD, MD,
DHA, DrPH). Regarding years of management experience, 44 per cent (68/154) of the
 LHS participants reported having more than 30 years of management experience in healthcare
30,3 settings; 34 per cent (51/154) had 20-29 years of management experience; and 22 per cent
(33/154) had less than 20 years of management experience.

Past evidence-based management experience

In the present study, participants were asked the percentage of their major management
334 decisions that had been made using the EBMgt approach in the past six months. A five-point
Likert scale was used: 0 per cent, 1-25 per cent, 26-50 per cent, 51-75 per cent and 76-100 per
cent. Figure 2 shows the per cent of major decisions made using an evidence-based practice
among the participants. Figure 2 shows that 9.8 per cent (15 of 153) reported that they never
used the EBMgt approach when making major management decisions. One participant did
not respond to the question. Forty-five participants (29.4 per cent) reported that 1-25 per cent
of their major decisions had been made using the EBMgt approach. Thirty-seven (24.2 per
cent) participants had 26-50 per cent of their major decisions made using the EBMgt
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approach, and 56 participants (36.6 per cent) reported having made 51-100 per cent of their
major decisions using the EBMgt approach. To have sufficient power to use this variable in
a regression model, the first three categories were collapsed (low use of EBMgt, 0-49 per cent),
and the last two were collapsed (high use of EBMgt, 50-100 per cent).

Participating healthcare organizations

In total, 152 respondents answered the question about the bed size of a healthcare
organization. Table II shows that out of the 152 participating healthcare organizations, 32
per cent (48/152) of hospitals had 25 beds or fewer, 22 per cent (33/152) had 26-99 beds, 14 per
cent (21/152) had 100-199 beds, 9 per cent (13/152) had 200-299 beds, 9 per cent (13/152) had
300-499 beds and 16 per cent (24/152) had 500 beds or more.
Table III shows information about the employee size of participating healthcare
organizations, while Table IV provides a Spearman’s/Cramer’s V coefficient table and associated
significance. Spearman’s correlation indicated statistically significant relationships between
healthcare leaders’ use of EBMgt and (1) healthcare organization bed size (rs ⫽ 0.217, n ⫽ 152,

Job title No. of participants (%)

Table I.
Distribution of Chief executive officer 133 86
participants’ job titles Chief administrative officer 18 12
(N ⫽ 154) Other health senior officer 3 2

35.0
29.4
30.0 26.8
24.2
25.0

20.0

15.0
9.8 9.8
10.0
Figure 2.
Per cent of using an 5.0
EBMgt approach
0.0
(n ⫽ 153)
0% 1-25% 26-50% 51-75% 76-100%
 p ⬍ 0.01) (2) and ‘attitude towards EBMgt’ (rs ⫽ 0.517, n ⫽ 152, Management
p ⬍ 0.01). There was also a statistically significant relationship between use of EBMgt and the in healthcare
number of organization employees (rs ⫽ 0.195, n ⫽ 152, p ⫽ 0.016). No nominal variables administration
exhibited statistically significant relationships with use of EBMgt based on Cramer’s V.
A stepwise multiple logistic regression model (backwards removal through evaluation of
the likelihood) was performed using the dichotomous version of “use of EBMgt” to
investigate demographic variables (age, gender, years of experience and educational level), 335
hospital characteristics (ownership, number of employees and bed size), and attitude
towards EBMgt with the reference category being set to “high use of EBMgt”. The entry
criterion was 0.05 with removal set at 0.10. The results of the logistic regression identified
three predictors that met the entry / exit criteria: attitude towards EBMgt, job title (CEO/
President, CAO, other with that category being the referent category) and the number of
employees (1-100, 101-300, 301-600, 601-900, 901-1200, 1,201 or more with this category being
the referent category). For the ownership level, 1 equals to “not-for-profit” and 2 equals to “for
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profit”.

Bed size No. of Healthcare organization (%)

⬍25 48 32 Table II.

26-99 33 22 Distribution of
100-199 21 14 participating
200-299 13 8 healthcare
300-499 13 8 organizations by bed
⬎500 24 16 size (n ⫽ 152)

No. of employees No. of Healthcare organization (%)

Table III.
100 or fewer 8 5 Distribution of
101-300 45 29 participating
301-600 30 20 healthcare
601-900 9 6 organizations by
901-1,200 10 6 employee size
1,201 or more 52 34 (N ⫽ 154)

Variables (1) (2) (3) (4) (5) (6) (7) (8) (9)

(1) Age (o) 1

(2) Gender (n) 0.133(x) 1
(3) Education (o) ⫺0.015 0.156(x) 1
(4) Job title (n) 0.102(x) 0.092(x) 0.067(x) 1
(5) No. of beds (o) ⫺0.105 0.205(x) 0.209** 0.266(x) 1
(6) No. of employees (o) ⫺0.087 0.202(x) 0.214** 0.218(x) 0.827** 1
(7) Ownership (n) 0.190(x) 0.185(x) 0.115(x) 0.150(x) 0.195(x) 0.195(x) 1
(8) EBMgt attitude (s) 0.056 0.185(x) 0.184* 0.665(x)** 0.265** 0.275** 0.505(x) 1
(9) Use of EBMgt (o) 0.075 0.205(x) 0.068 0.188(x) 0.217** 0.195* 0.153(x) 0.517** 1 Table IV.
Spearman’s
Notes: N ⫽ 152; *** p ⬍ 0.001; ** p ⬍ 0.01; * p ⬍ 0.05 (2-tailed) (n) ⫽ nominal; (o) ⫽ ordinal(x); (s) ⫽ scale; correlation/Cramer’s V
(x) ⫽ Cramer’s V coefficient table
 LHS The multiple logistic regression model correctly classified 75.3 per cent of all
30,3 observations, 84.2 per cent of those with low use of EBMgt and 60 per cent of those with
high use, which is an improvement over the 63.8 per cent classified correctly under the
null (100 per cent of the low use and 0 per cent of the high use). Odds ratio (OR) estimates
and confidence intervals for the final model are shown in Table V. The OR for EBMgt
Attitude is 3.180 (1.841, 5.49), indicating a positive relationship between use and attitude
336 as would be expected. Further, the model indicated that CAOs were less likely to use
EBMgt versus CEOs / Presidents [OR ⫽ 0.103 (0.015, 0.712)]. This suggests that
healthcare organizational leaders seek grounding in evidence more frequently than other
C-staff. Surprisingly, organizations with between 101 and 300 employees were less likely
to report use of EBMgt versus organizations with less than 100 employees [OR ⫽ 0.060
(0.007, 0.557)]. Perhaps, smaller organizations require use of EBMgt for survival, or
perhaps it is simply easier for smaller organizations to use EBMgt.
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Type of evidence
Ten types of evidence were assessed in the survey using a seven-point Likert scale. The types
of evidence included case studies, organizational data, peer/expert opinions, personal
experiences, qualitative research, quantitative research, randomized controlled studies,
scientific research findings, stakeholders’ values and concerns and systematic reviews/
meta-analyses. The participants were asked to identify the types of evidence they used for
decision-making in the past six months and the frequency with which they used evidence for
their decision-making in healthcare management. A five-point Likert scale was adopted
for frequency of use of evidence: daily, weekly, monthly, less than once a month and never.
Figure 3 presents the types of evidence consulted by participating healthcare leaders and the
frequency of use of evidence for healthcare leaders’ decision-making.
The results in Figure 3 show that personal professional experiences (87 per cent or 134/
154), organizational data (84 per cent or 130/154), stakeholders’ values and concerns (63 per
cent or 98/154) and peer/expert opinions (50 per cent or 77/154) were the top four types of
evidence used for decision-making by participants daily and weekly. Case study (75 per cent
or 115/154), scientific research findings (75 per cent or 115/154), quantitative research (70 per
cent or 108/154) and qualitative research (68 per cent or 105/154) were the top four types of
evidence used by participants monthly or less than once a month. However, 35 per cent

Variables Odds ratio 95% CI

Constant 0.595
EBMgt Attitude 3.180*** 1.841 5.49
Joba
CAO 0.103* 0.015 0.712
Other 2.588 0.151 44.275
No. of employeesb
101-300 0.060* 0.007 0.557
301-600 0.142^ 0.015 1.301
601-900 0.832 0.060 11.516
901-1,200 0.154 0.013 1.879
Table V. 1,201 or more 0.137^ 0.016 1.204
Coefficient table for
the multiple logistic Notes: a CEO/President is comparative base; b
⬍⫽100 is comparative base ^p ⬍ 0.10; * p ⬍ 0.05;
regression model **
p ⬍ 0.01; *** p ⬍ 0.001
 (54/154) of participants reported having never consulted RCT studies for decision-making, 13 Management
per cent (20/154) as having never consulted systematic reviews/meta-analysis for in healthcare
decision-making, 10 per cent (16/154) as having never consulted case studies and scientific
research findings for their decision-making, 6.5 per cent (10/154) as having never consulted
administration
quantitative research, and 6 per cent (9/154) as having never consulted qualitative research
for decision-making.

Discussion
337
The EBM movement has influenced prominent scholars and health leaders in healthcare
management. They have promoted the principles of EBM and applied them to healthcare
management decision-making. Some of them have published important articles and strongly
advocated practicing EBMgt in healthcare management (Kovner et al., 2000; Walshe and
Rundall, 2001; Kovner and Rundall, 2006). However, EBMgt has not been widely used by
healthcare administrators in the USA before (Kovner and Rundall, 2006; Arndt and Bigelow,
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2009). The present study was conducted to identify whether healthcare administrators and
managers have adopted an evidence-based approach in their decision-making. The study
results showed that 90 per cent of participants reported having used an EBMgt approach at
various levels when making decisions and 10 per cent of participants as having never used
the EBMgt approach for decision-making.
Concerning the attitude toward EBMgt, Kovner and Rundall (2006) conducted an
interview among health managers. The study’s results showed that health managers had a
negative attitude toward EBMgt. Things are changing rapidly in the US healthcare
environment and particularly both big data science and healthcare administrators are
encouraged to use EBMgt when making decisions rather than depending on personal
experience and opinions. Evidence-based practice is considered to be the best model in
healthcare. All this continues to influence healthcare administrators to adopt EBMgt for
decision-making in their healthcare organizations. The present study shows that healthcare
leaders had positive attitudes toward EBMgt, which differs from the one obtained by Kovner
and Rundall (2006).
The present study also indicates that there was a statistically significant association
between the use of EBMgt and healthcare leaders’ attitudes toward EBMgt. The multiple
logistic regression model suggests that the OR for EBMgt Attitude is 3.180 (1.841, 5.49). An
OR is a measure of association between an exposure and an outcome. It is commonly used in
case-control studies and can also be used in the cross-sectional study design. The OR in the
present study was to measure the association between the use of EBMgt and attitude
towards EBMgt (hospital characteristics, etc.). The multiple logistic regression revealed that
a positive attitude towards EBMgt increased the odds of EBMg use. This means that

140
120
100
80
Daily
60
40 Weekly
20 Figure 3.
Monthly
0 Frequency use of
Less than once a month evidence for
Never decision-making in
Healthcare
Management
(N ⫽ 154)
 LHS participating healthcare leaders who had a high positive attitude towards EBMgt were more
30,3 likely to use EBMgt for decision-making than those who had a negative attitude. The study
results indicate a positive relationship between attitude and use (behavior in performance).
Based on the theory of planned behavior (TPB) developed by Ajzen (1988 and 1991), attitude
can be a factor that plays an important role in predicting people’s behavior in performance.
The present study supports the statement of the TPB theory.
338 A debate exists in the literature regarding what kind of evidence should be used for
decision-making in management (Young, 2002) and whether there is strong evidence that can
be applied to EBMgt decision-making (Liang et al., 2011). Liang et al. conducted a research
project which focused on clarifying what constituted evidence from managers’ perspectives,
how managers perceived the importance of a range of evidence types and how often and for
what types of decisions they used evidence for decision-making. According to Liang et al.
“evidence” was defined as the range of information types used in a variety of ways in
management decision-making processes. Liang et al. (2011) listed seven evidence types and
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participants were required to rate their importance and frequency of use in relation to the
decision-making process. These included internally developed data, best practice,
stakeholder/consumer preference, examples of external practice, expert opinions,
quantitative research and qualitative research (Liang et al., 2011). These types of evidence
were considered different from the EBM pyramid. The EBM pyramid is developed based on
the type of research designs in the field of medicine and health sciences. For example, an
expert opinion is considered to be a low level of evidence in the EBM pyramid because
personal opinions present some bias as compared to randomized controlled studies.
However, Liang’s study findings showed that healthcare managers perceived an expert
opinion as a valuable form of evidence. Health managers rated information developed within
the organization as the most important and most frequently used type of evidence among the
seven types of evidence. The study results by Liang et al. (2011) also showed that health
managers viewed evidence broadly and they acknowledged that personal experience had a
significant impact on their decision-making. Walshe and Rundall (2001) suggested that the
high number of managers reporting the use of personal experience over other forms of
evidence can be explained by these forms of evidence being highly valued in the
management sphere. The study findings by Guo et al. (2015) and Liang et al. (2011) were
consistent with the present research results that personal professional experience and
organizational data were the top two types of evidence consulted daily and weekly by
healthcare leaders for management decision-making.
Dopson and colleagues mentioned that healthcare managers do not often consult
management research (Dopson et al., 2013). The results from the present study indicated that
case study and scientific research findings, which included qualitative and quantitative
research, were consulted for decision-making monthly or less than once a month. In addition,
10 per cent of participants reported having never consulted case studies and scientific
research findings for their decision-making. About 6 per cent never consulted either
quantitative research or qualitative research for decision-making. The present study
findings were consistent with the above in that qualitative and quantitative research
evidence were found to be not often used by healthcare managers (Liang et al., 2011; Dopson
et al., 2013).
With regard to the use of EBMgt, scholars have tried to explain what made it difficult for
CEOs and managers to practice EBMgt. One of the perceived reasons was that there was not
enough good evidence for managers and executives to use and the existing evidence did not
quite apply (Pfeffer and Sutton, 2006). Bigelow and Arndt (2003) pointed out that, as CEOs
are faced with the responsibility for their organization’s performance, they wanted to know
 whether anything in the research would help them run their organizations better. However, Management
the focus in healthcare research was frequently on research implications, not on practical in healthcare
management. Some scholars acknowledged that a limited research base for management
interventions (Hewison, 1997) and a gap between research and practice in healthcare
administration
management (Bigelow and Arndt, 2003). The literature also suggests a need to expand the
methods utilized by health services researchers to make the research more relevant to health
care managers (Alexander et al., 2007). Obviously, more work is needed to reduce the gap
between research and practice and to make it easier for practicing healthcare administrators
339
to use the best available management research evidence when implementing EBMgt in their
management decision-making.
Regarding level of evidence, some scholars do not think that the EBM pyramid applies to
management decision-making and other scholars argue that evidence should be viewed
broadly to include both research and non-research evidence, and that healthcare
administrators and managers should use a variety of forms of knowledge, drawing on formal
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academic knowledge and experiential knowledge, as well as consulting trusted colleagues

(Liang et al., 2011). In EBM and health sciences, RCT studies and systematic reviews/meta
analyses are considered high levels of research. The present study findings show that 35 per
cent of the participants reported never having consulted RCT studies for decision-making
and 13 per cent of the participants never consulted systematic reviews/meta-analyses for
decision-making. This finding indicates two issues. The first issue is that RCTs and
systematic reviews/meta-analyses in management and business have not been published as
much as in the field of medicine and health sciences. This might be a factor that hinders
healthcare leaders’ consulting RCTs and systematic reviews/meta-analyses when practicing
EBMgt in healthcare management. Reay et al. (2009) carried out a systematic review of the
literature to calls for increased use of EBMgt. The findings of the systematic review showed
that a large number of articles related to EBMgt are published, but most provided opinion
and anecdotal information on the encouragement to adopt EBMgt. Therefore, scholars in
healthcare management and business need to increase research to generate stronger
evidence related to the impact of EBMgt on organizational performance (Reay et al., 2009).
Another study was published using a scoping review of systematic reviews and
meta-analyses to determine the availability and accessibility of evidence for healthcare
managers in PubMed, an important medical database (Jaana et al., 2013). The review results
showed that 14 meta-analyses and 61systematic reviews met the inclusion criteria. Most
reviews appeared in medical journals (53 per cent), originated in the USA (29 per cent) and
UK (22 per cent), were hospital-based (55 per cent) and targeted clinical providers (55 per
cent). Review topics included health services organizations (34 per cent), quality/patient
safety (17 per cent), information technology (15 per cent), organization/workplace
management (13 per cent) and healthcare workforce (12 per cent). One finding in the study of
Jaana et al. (2013) was that most systematic reviews addressed clinical topics of relevance to
managers, but not management-related interventions.
As a result of the debate on EBMgt, scholars think that evidence in management should
be viewed in a broad context. Based on the CEBM, four sources of the best available evidence
are identified for the decision-making process. They are scientific research findings,
professional experience and judgment, organizational data and facts in conjunction with
stakeholders’ values and concerns (CEBM, 2014). The present study supports the statement
made by the CEBM and agrees that the four pieces of evidence are considered useful evidence
for management decision-making. Furthermore, consulting scientific research findings,
including both quantitate and quantitative research findings, should be done in conjunction
with professional experience, organizational data and stakeholders’ values, when healthcare
 LHS managers and administrators make decisions. The researchers of the present study support
30,3 that an evidence-based practice would improve the competence of the decision-makers and
their motivation to use more scientific methods in healthcare management decision-making
(Kovner and Rundall, 2006; Pfeffer and Sutton, 2006).

Implications of the study

340 The present study has important implications for healthcare leaders and administrators. First of
all, the findings presented in this study could help policy-makers and professional associations
better understand healthcare leaders’ decision-making style. The outcomes of the study can be
used for exploring some possible interventions that might increase the use of an evidence-based
approach in healthcare management and reduce barriers to the adoption of EBMgt in the future,
for example to reduce the gap between research and practice in healthcare management. Second,
few studies on the practice of EBMgt in healthcare management have been published and not
much is known about healthcare administrators’ attitude towards EBMgt in the current US
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healthcare environment. The results of this study indicated that participating healthcare leaders
had an overall positive attitude toward EBMgt and that they used an EBMgt approach for
decision-making at various levels. The findings of the present study contribute to the scholarly
literature in the practice of EBMgt in healthcare administration and management.

Limitations
This study has at least two limitations. The first limitation is that a response bias may have
occurred due to self-reporting by the participants. The second limitation is that the response
rate of returning the survey was low, so the results may not be representative of the whole
study population.

Recommendations and conclusions

Based on the study findings, more efforts in promoting a culture that embraces EBMgt
among healthcare leaders are needed. Healthcare leaders need to more often consult scientific
research findings for decision-making, including both qualitative and quantitative research
in healthcare management, in addition to professional experience, organizational data and
stakeholders’ values and concerns.
Professional associations, universities, private sectors and research agencies need to
bring researchers, practitioners and educators together to conduct more EBMgt research,
collect and organize EBMgt information resources and provide the synthesized information
for practicing healthcare leaders and managers. This effort may help healthcare leaders to
more easily consult the best available research evidence for their decision-making.
Finally, an effort should be made to translate research evidence into management practice
so that healthcare leaders and managers can have a meaningful use of research findings in
their healthcare organizations, which may help guide them in making better decisions.

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Corresponding author
Ruiling Guo can be contacted at: [email protected]
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