Managers in the care sector must learn to act evidence-based

October 30, 2014

One of the reasons for the friction between doctors and managers is the fact that doctors have to work according to protocol, whereas managers have to implement all kinds of changes without producing evidence, says professor Jo Caris.

Beeld: © Nationale Beeldbank

Doctors, nurses or other care providers are continuously subjected to protocols while doing their jobs. There is a protocol for virtually every act or operation that they perform. Consider, for example, the protocol ‘Wash hands’. If a care professional is required to wash his/her hands on occasion more than 60 times a day, according to protocol, then we can expect that this will not always be done or will not always be done properly.

Before an anesthetist is allowed to administer anesthesia in the OR, the amount is first checked, not only be the anesthetist, but also by 2 other people. Multiple checks by different people do not lead to a reduction in errors, on the contrary. Sharing responsibility often leads to negligence: those concerned may too easily rely on others to do the checks. The same is found in sectors other than the health care sector.

Number of rules not beneficial to the result

Don't get me wrong, I do not reject quality management. Of course it is important that care professionals observe proper hygiene. Or that the correct amount of medication is administered to a patient. I just think that the number of rules does no good for the ultimate result.

When it comes to steering behavior, there are three aspects that require our attention, namely the motivation and the capacity of those concerned, and opportunity (willingness, capability and opportunity). All of the protocols mentioned steer towards motivation. They are based on the assumption that professionals must be motivated to work safely and hygienically. Of course, you will not find a professional in the health care sector who thinks that he/she does not need to observe hygiene and safety regulations. Quality and safety are important to every professional. Motivation is not the problem, except for the fact that there is (justifiable) doubt concerning the relationship between the number of rules on the one hand and quality and safety on the other.

The reason for the number of guidelines may lie in the fact that professionals must work in a disciplined manner and this may be connected to quality and safety. But this concerns the capacity of the professionals (the ability to work in a disciplined manner) and this capacity is not always stimulated by implementing rules. It may also depend upon the opportunity, the circumstances. Observing rules may be at odds with work-related pressure or the desired speed. In any event, there is more than enough reason to take a closer look at the problem and at the best approach to deal with it.

Whatever they want

In stark contrast with the protocols of professionals, is the lack of obligation on the part of managers and administrators with regards to their providing direction. Besides general legislation and accountancy demands, they can do whatever they want. Managers can solve a problem, before it has even been ascertained that it actually is a problem, by implementing a solution that has never been proven and by rolling it out across the work floor. Restructuring, adding managers, removing a layer, result-responsible units, self-managing teams, new spearheads, et cetera, are examples of non-proven interventions that seem more like fads. Solutions of this kind have consequences for large groups of employees and therefore, perhaps indirectly, for patients and clients as well. Administrators and managers are not obligated to act in an evidence-based manner. An evidence-based approach starts with a careful diagnosis of the problem, ascertaining whether there are approaches that have proven to be or were shown to be effective in the past. The next step is to select a certain approach and examine the possible consequences of that particular approach, and finally adjusting the approach, if necessary.

Managers and professionals do not always work together cooperatively and harmoniously. Among other things, this often has to do with the disproportion between the two groups, with respect to the meticulousness and the evidence-based nature of their actions. 

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