Evidence-Based Management Practice and Leadership

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Evidence-Based Management Practice and Leadership

• L. Michele Issel, PhD, RN
• UIC, SPH
• MCH Leadership Conf
• April 2002

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Objectives of Session

• Appreciate the breadth and depth of scientific
  knowledge applicable to management practice
• Be able to list three theories that can be used
  in management practice
• List at least two sources of obtaining current
  management knowledge
• Make a commitment to own growth in the area of
  practicing science-based management and leadership

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Premises

• Science and theory for practice of leadership and
  management
• Practice needs to be based on science
• Can integrate management and organizational
  science and theory into practice
• All applicable to MCH
• Tomorrow will not be like today or yesterday

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Evidence Based Practice

• Management is a practice, and research identifies
  most effective actions under what conditions

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No need to fly (only) by the seat of your pants

• Use the available technology and instruments

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What is Evidence Based?

• Consistent and judicious use of the best evidence
  when making decisions regarding delivery of
  treatment or interventions.
• In management, intentional actions are
  interventions.

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Isnt Evidence Evident? Well

• Latest research reports
• May or may not be sound, rigorous research
• May or may not have results consistent with past
  studies
• Own practice experiences
• Human recall is notoriously biased
• Unknown if same results can happen with other
  practitioners
• Existing practice guidelines
• May be based on outdated data and on habits

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Evidence Quadrants

Many Studies
Ideal, strongest evidence
Ambiguous evidence
High Quality (Rigor)
Low Quality
Barely of interest
Strongly suggestive
Single Study
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Quality Continuum

Randomized, double blind clinical trial with
large sample size
Quasi-experimental, small sample
Quasi-experimental, large sample
Descriptive anecdotal
High
Low
Quality of Study (Rigor)
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References on Assessing Study Quality

• Brown, S. (1991). Nursing Research, 40352-355.
• Easy to use tool to assess the quality of a
  study.
• Moher, D. et al (1995). Controlled Clinical
  Trials, 16 62-73.
• Review of 25 tools to assess study quality.

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Steps to Establish the Evidence for a Practice

• Evidence Review
• I. Define Problem
• II. Locate Studies
• III. Evaluate Studies
• IV. Determine Strength of Evidence
• Evidence-Based Practice (EBP)
• V. Develop Guidelines
• VI. Change Practice

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Evidence in Organizational Science

• Look for meta-analyses and literature synthesis
• ABI INFORM as the library database
• Look for body of work by one scholar
• Accumulation across several studies
• Look for work done in variety of organizations
• Accumulation of knowledge across settings

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First, Aim for Leadership

• Flexibility and responsiveness
• Innovation of approaches and solutions
• Trail blaze into new risky territory
• Embrace change
• See opportunities, the full half

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Leadership how?

• Self-awareness
• With passion, enthusiasm
• With intelligence
• With knowledge
• With confidence
• With intent

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Leadership Management

• Strategy focused
• Set mission
• Context awareness
• Encouragement

• Operations focus
• Follow mission
• Content awareness
• Control

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Managing What ?

• People
• Ideas
• Processes
• Images and Perceptions
• Communication
• Time

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Managing People

• Motivation
• Conflict
• Ethics
• Legal parameters
• Professionalism

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The 3 As

• Autonomy
• Authority
• Accountability
• Responsibility

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Theory for Managing People

• Motivation theories
• Whistle blowing theories
• Mentoring theories
• Role theory

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Motivation Theory and Science (from Mitchells
summary)

• Efficacy, expectancy goals
• Self-regulation, control, switching, habits
• Emotions, affect, mood
• Needs (hygiene factors), dispositional
• Task design
• Justice, rewards, reinforcement
• Influence, culture

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Evidence for People Management

• High motivation work environments have these
  characteristics (Jeff Pfeffer)
• Employment stability
• Participation in decision making
• Performance reward
• Train employees
• Open book management

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Evidence-Based People Management

• To have a high motivation work environment
• Keep employees
• Involve staff in decision making
• Reward performance
• Invest in training employees
• Give feedback to employees

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Managing Ideas

• Innovations
• Knowledge
• Ideologies
• Learning
• Creativity

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Theory for Managing Ideas

• Diffusion of innovation theory
• Organizational learning theory
• Theories of creativity
• Knowledge-based vs. knowledge-generating
  organization

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Evidence for Idea Management

• Management of Innovation.
• Approximately 50 of innovators come from middle
  management or front-line staff
• Innovators used comprehensive planning as a mode
  of analysis leading to innovation
• Brinis (2001) Am Review Pub Admin.

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Evidence-Based Idea Management

• Managing Innovation.
• Listen to and seek ideas from middle management
  or front-line staff
• Use comprehensive planning as starting point
  leading to innovation

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Managing Processes

• Decision making
• Change
• Career advancement
• Group work and interactions
• Tasks (use of interventions, job performance)
• Attention

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Theory for Managing Processes

• Participation in decision making theories
• Theories of organizational change
• Work group perspectives
• Autonomous
• Work group effectiveness
• Career advancement
• Mentoring
• Organizational constraints (glass ceiling)

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Evidence for Process Management

• Decision making.
• Participation of staff in decision making about
  strategy, operations, and marketing is related to
  more effective organizations
• Participation of staff in decision making is
  better patient outcomes
• Anderson Issel

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Evidence-Based Process Management

• Managing decision processes
• Involve staff in identifying the issues, seeking
  solutions and choosing solutions
• Involve staff in decision making that affects the
  organization, not just their job

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Managing Images and Perception

• Symbols and rituals
• Marketing principles
• Sense making and meaning making
• Personal culture
• Organizational culture

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Theory for Managing Perceptions

• Organizational climate and culture
• Typologies
• Diversity in meanings
• Organizational cognition theories
• Learning organizations
• Sense-making
• Weicks social organizing

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Evidence for Perception Management

• Weicks work on attention and interpretations in
  high velocity environments
• When things are happening fast, people miss
  information and make assumptions
• People in organizations retrospectively make
  sense of the past events
• People in organizations create the future they
  are planning for

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Evidence-Based Perception Management

• Managing perceptions
• Seek lots of diverse information to understand
  what is going on
• Defer to expertise that exists across/up-down the
  organization
• Look for information that disconfirms your ideas

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Managing Communication

• Interpersonal dialogues
• Modes and medium of communication
• Mass communications
• Interorganizational communication and networks

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Theory for Managing Communication

• Interpersonal communication theory
• Theory of language
• Mass communication theory
• Speech pathology theories
• Network theory and science
• Individual level
• Organizational level

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Communication and Networks

• Boundary Spanning
• Density and Homophily
• Network Characteristics and Effects
• Boundary spanners gather information
• Strength of weak ties

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Communication Mode

• Daft and Engles Media Richness
• Medial richness is the degree to which a cues are
  given that can be used to interpret the message
• Media richness increases understanding
• Face to face communication is richest media

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Evidence for Communication Management

• Baltes et al. (2002) did a meta-analysis of 22
  studies about computer mediated communication
  versus face to face communication.
• Computer use is associated with
• more negative work outcomes
• decrease group effectiveness
• increased time to decision
• decreased satisfaction

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Evidence-Based Communication Management

• Managing communication
• Be selective about when use computer versus
  in-person communication
• Match the mode of communication with the need for
  rich information
• Use the weak links in interpersonal and
  professional networks to gain new information

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Managing Time

• Personal time
• Project time
• Work time

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Theory for Managing Time

• Cue theory
• Negotiation theory
• Attention management
• Multi-tasking

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Evidence for Time Management

• Stuhlmacher (1998) meta-analysis of effect of
  time pressure on negotiation in 23 studies
• Greater time pressure was related to greater
  cooperative strategy being used, especially in
  single issue negotiations, when there is large
  incentive for cooperation, and parties can be
  flexible in meeting demands

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Evidence-Based Time Management

• Managing time
• Anticipate effect of time frame on own actions
  and emotions and those of others
• Anticipate the interaction of time frame with
  perceptions and responses

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From Science to Practice

• Changing ones own behavior requires
• intention,
• attention, and
• skill

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Learning Opportunities

• Conferences
• University courses and programs
• Hired consultants
• Mentors
• Bookstores
• Journal club
• Listserves

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Collaborate with Researchers

• Stories with a lesson Share them to begin the
  search for explanations
• Organization or program as a laboratory for
  testing management and leadership approaches

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Where to get the latest management science

• Journals
• Harvard Business Review
• MITs Sloan Management Review
• J of Public Health Management and Practice
• Healthcare Management Review
• J of Nursing Administration

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Who to read? Almost anyone

• Managing Processes
• Warren Bennis
• Managing Perceptions
• Karl Weick
• Managing Communications
• Fishers Getting to Yes

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NY Times Business Best SellerFrom March 17 list

• Leading Quietly by Badaracco
• 4 yr study showing that great leadership is
  generally conducted in careful, thoughtful, small
  and practical efforts.

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NY Times Business Best SellersFrom April 14 List

• Primal Leadership by Coleman , Boyatzis McKee
• putting emotional intelligence to work
• Who moved my cheese? By Johnson
• techniques for dealing with workplace change

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Your turn to participate

• What aspects of my work are managerial and what
  aspects are leadership?
• What questions do I have about management and
  leadership? (curiosity)
• Where can I look for answers to those questions?

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Your turn to participate

• Take a moment and write
• Two things you intend to do based on this
  presentation
• Two things you learned that you dont want to
  forget

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Make a commitment

• By next year, I will have a science based answer
  to at least one of my management practice
  questions.

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Sound Bytes

• Remember small is big small changes have big
  effects
• Managing happens, regardless of being planned
• Fads of science become fads in practice change
  is perpetual

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Thank You