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Evidence-Based Practice. Lunchbijeenkomst 14 maart 2013 . Post Grad (E)MBA Business Schools. HBO. Universiteit. Aanleiding. Wat moet een student in de praktijk straks kunnen: - zelf onderzoek doen? - onderzoek kunnen beoordelen + toepassen? Wat betekent dat voor het curriculum?

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Evidence-Based Practice

Lunchbijeenkomst

14 maart 2013


Post Grad

(E)MBA

Business Schools

HBO

Universiteit


Aanleiding

Wat moet een student in de praktijk straks kunnen:

- zelf onderzoek doen?

- onderzoek kunnen beoordelen + toepassen?

Wat betekent dat voor het curriculum?

Wat betekent dat voor de accreditatie?


HBO standaard (2009)

“In onze moderne samenleving is het cruciaal dat hbo-bachelors over een onderzoekend vermogen beschikken dat leidt tot reflectie, tot evidence-based practice, en tot innovatie.”



  • Wat is het?

  • Waarkomt het vandaan?

  • Hoe ziet het eruit in eenopleiding?

  • Hoe zit datbij 4e jaarsstudenten?


Evidence based practice:

Wat is het?


Evidence-based practice

Uitgangspunt bij evidence-based practice is dat beslissingen gebaseerd dienen te zijn op een combinatie van wetenschappelijk denken en de best beschikbare 'evidence'.


Evidence based practice

Met het begrip 'evidence' wordt niet meer bedoeld dan 'informatie'.

Dit kan informatie zijn afkomstig uit wetenschappelijk onderzoek, maar ook interne bedrijfsinformatie en zelfs persoonlijke ervaring geldt als 'evidence’.


Evidence based practice

In principe neemt iedere manager dus beslissingen op basis van 'evidence'.

De meeste managers besteden echter nauwelijks aandacht aan de kwaliteit van de 'evidence' waarop ze hun beslissingen baseren.


Evidence-based practice:

  • kritisch en wetenschappelijk denken

  • van verschillende informatiebronnen gebruik maken

  • de beschikbare evidence kritisch tegen het licht houden

  • denken in termen van waarschijnlijkheid in plaats van 'golden bullets'.


Evidence based practice

Best available organizational evidence

Best available scientific evidence

Evidence-based decision

Professional expertise andjudgement

Stakeholders’ values and concerns


Evidence based practice:

Waarkomt het vandaan?


What field is this?

  • “there is a large research-user gap”

  • “practitioners do not read academic journals”

  • “the findings of research into what is an effective intervention are not being translated into actual practice”

  • “academics not practitioners are driving the research agenda”

  • “the relevance, quality and applicability of research is questionable”

  • “practice is being driven more by fads and fashions than research”

  • “many practices are doing more harm than good”


Medicine founding fathers
Medicine: Founding fathers

David Sackett

Gordon Guyatt

McMaster University Medical School, Canada



Problem I: persistent convictions

if you’re hyperventilating

breathe into a bag


Problem I: persistent convictions

elderly people who have an irregular heartbeat are much more likely to die of coronary disease

give them a drug that reduces the number of irregular beats


How 40,000 cardiologists can be wrong

In the early1980s newly introduced anti-arrhythmic drugs were found to behighly successful at suppressing arrhythmias.

Notuntil a RCT was performed was it realized that, althoughthese drugs suppressed arrhythmias, they actually increasedmortality.

By the time the results of this trial were published, at least100,000 such patients had been taking these drugs.


  • David Sackett

  • Half of what you learn in medical school will be shown to be either dead wrong or out-of-date within 5 years of your graduation; the trouble is that nobody can tell you which half.

  • The most important thing to learn is how to learn on your own: search for the evidence!

  • (Remember that your teachers are as full of bullshit as your parents)


Problem ii too much information
Problem II: too much information

  • More than 1 million articles in 40,000 medical journals per year (= 1995; now probably more than 2 million). For a specialist to keep up this means reading 25 articles every day (for a GP more than 100!)


Problem ii too much information1
Problem II: too much information

  • HRM: 1,350 articles in 2010 (ABI/INFORM). For an HR manager to keep up this means reading 3 to 4 articles every day (for a ‘general’ manager more than 50!)

BTW: most of the research is seriously flawed or irrelevant for practice


The 5 steps EBP

  • Formulate a focused question (Ask)

  • Search for the best available evidence (Acquire)

  • Critically appraise the evidence (Appraise)

  • Integrate the evidence with your professional expertise and apply (Apply)

  • Monitor the outcome (Assess)

Zelfonderzoekdoen?


Evidence-Based Practice

1991Medicine

1998Education

1999Social care, public policy

2000Nursing

2000Criminal justice

????Management?


Evidence based practice:

Hoe ziet het eruit in de opleiding?


Evidence-based practice

Fase 1: Het ontwikkelen van kritisch en wetenschappelijk denken dat leidt tot een professioneel-kritische attitude met betrekking tot organisatievraagstukken

Fase 2: Het kunnen formuleren van een expliciete vraag en op basis van deze vraag kunnen zoeken in online databases naar uitkomst van relevant wetenschappelijk onderzoek.

Fase 3: Het kritisch kunnen beoordelen van wetenschappelijke en organizational evidence (criticalappraisal)

Fase 4: Uitkomst van wetenschappelijk onderzoek kunnen toepassen in de eigen beroepspraktijk (application of science)


Evidence based practice

Best available organizational evidence

Best available scientific evidence

Evidence-based decision

Professional expertise andjudgment

Stakeholders’ values and concerns


Waarom(wetenschappelijk) onderzoek?


Trust me, 20 years of experience



Richard Feynman

“The first principle is thatyou must not fool yourself - andyou are the easiest person to fool”.



Het feilbarebrein

  • System 1

  • Snel, actie

  • Intuitief, associatief

  • shortcuts & biasses

  • System 2

  • Langzaam (lui!)

  • Rationeel

  • Nadenken



Systeem 1: het feilbarebrein

  • Seeing order in randomness

  • Mental corner cutting

  • Misinterpretation of incomplete data

  • Halo effect

  • False consensus effect

  • Group think

  • Self serving bias

  • Sunk cost fallacy

  • Cognitive dissonance reduction

  • Confirmation bias

  • Authority bias

  • Small numbers fallacy

  • In-group bias

  • Recall bias

  • Anchoring bias

  • Inaccurate covariation detection

  • Distortions due to plausibility


Waaromonderzoek?

  • Het feilbarebrein

  • Meningen

  • Assumpties (aannames)

  • Overtuigingen

  • Persoonlijkeervaringen

BIAS

  • Wetenschappelijkonderzoek

  • Feiten

  • Evidence: bewijs / aanwijzingen


Fase 1: Kritisch & wetenschappelijkdenken

Denkfouten

Informatiebronnen

Mythbusting

Assumpties


7 Denkfouten(die u beteraananderenkuntoverlaten)

Seeing order in randomness

Confirmation bias

Small numbers fallacy

Outcome bias

Halo effect

Authority bias

Group think


Seeing order in randomness

  • EenType I foutof eenvalspositief:denkendatereenpatroon / verband is terwijldater in het echtniet is.

  • EenType II foutof eenvalsnegatief:denkendatergeenpatroon / verband is terwijldater in het echtwel is

Dr. Michael Shermer (Director of the Skeptics Society)


Het feilbarebrein: patern recognition

  • EenType I foutof eenvalspositief: denkendat het geritsel in de bosjeseengevaarlijkroofdier is, terwijl het gewoon de wind is (goedkoopfoutje)


Het feilbarebrein: patern recognition

  • EenType II foutof eenvalsnegatief: denkendat het geritsel in de bosjesgewoon de wind is, terwijl het eengevaarlijkroofdier is (duurfoutje)


Het feilbarebrein: patern recognition

Het probleem met patroonherkenning:

Het kritischbeoordelen of ersprake is van een Type I of een Type II fout is best moeilijk, (vooral in ‘split second life and death’ situaties), dus de default positie is omaantenemendatallepatronenechtzijn.


Het feilbarebrein: patern recognition

  • EenType I foutof eenvalspositief: denkendat het geritsel in de bosjeseengevaarlijkroofdier is, terwijl het gewoon de wind is (goedkoopfoutje)

DEFAULT

  • EenType II foutof eenvalsnegatief: denkendat het geritsel in de bosjesgewoon de wind is, terwijl het eengevaarlijkroofdier is (duurfoutje)


Het feilbarebrein: patern recognition

Ookervarenmensen en experts zienpatronen en verbandenwaarzenietzijn.

stress & lifestyle

peptic ulcer


Oct 2005

Peptic ulcer – an infectious disease!

This year's Nobel Prize in Physiology or Medicine goes to Barry Marshall and Robin Warren, who with tenacity and a prepared mind challenged prevailing dogmas. By using technologies generally available (fibre endoscopy, silver staining of histological sections and culture techniques for microaerophilic bacteria), they made an irrefutable case that the bacterium Helicobacter pylori is causing disease. By culturing the bacteria they made them amenable to scientific study.

In 1982, when this bacterium was discovered by Marshall and Warren, stress and lifestyle were considered the major causes of peptic ulcer disease. It is now

firmly established that Helicobacter pylori causes more then 90% of duodenal ulcers. The link between Helicobacter pylori infection and peptic ulcer disease has been established through studies of human volunteers, antibiotic treatment studies and epidemiological studies.


Het feilbarebrein: patern recognition

  • Ook slimme mensen houden er verkeerde ideeën op na, niet omdat ze dom of eigenwijs zijn, maar omdat het de meest logische conclusie is op basis van hun eigen ervaringen.

(systeem 1 doetaltijdmee!)


Evidence-based practice

Fase 1: Het ontwikkelen van kritisch en wetenschappelijk denken dat leidt tot een professioneel-kritische attitude met betrekking tot organisatievraagstukken

Fase 2: Het kunnen formuleren van een expliciete vraag en op basis van deze vraag kunnen zoeken in online databases naar uitkomst van relevant wetenschappelijk onderzoek.

Fase 3: Het kritisch kunnen beoordelen van wetenschappelijke en organizational evidence (criticalappraisal)

Fase 4: Uitkomst van wetenschappelijk onderzoek kunnen toepassen in de eigen beroepspraktijk (application of science)


5-step approach

EBMgt is a 5-step approach

Formulate an answerable question (PICOC)

Search for the best available evidence

Critically appraise the quality of the found evidence

Integrate the evidence with managerial expertise and organizational concerns and apply

Monitor and evaluate the results


Formulate a focused question


Focused question?

  • Does team-building work?

  • What are the costs and benefits of self-steering teams?

  • What are the success factors for culture change?

  • Does management development improve the performance of managers?

  • Does employee participation prevent resistance to change?

  • How do employees feel about 360 degree feedback?


Foreground question?

  • What is a ‘team’?

  • What kind of teams?

  • In what contexts/settings?

  • What counts as ‘team-building’?

  • What does ‘work’ mean?

  • What outcomes are relevant?

  • Over what time periods?

  • Does team-building work?


Answerable question: PICOC

P= Population

I = Intervention or success factor

C= Comparison

O= Outcome

C = Context



Searching evidence

What do we search?


Current Information

Overview of a subject

General background

Academic Information

Statistical Information

Theories about a subject

Company information

What do we search?



Searching evidence

Where do we search?



Databases

  • ABI/INFORM

  • Business Source Elite

  • PsycINFO

  • Web of Knowledge

  • ERIC

  • Google Scholar



Searching evidence

How do we search?

Search Strategy


Two types of search strategies

Building blocks method

Snowball method

Search strategy

Two types of search strategies



Exercise: Search for evidence

Search in ABI/Inform:

How many articles has Stephen Covey published in peer reviewed journals?

How many of these articles are based on scientific research?

Are there articles (by other authors) that are critical of Covey’s 7 Habits?

How many of these critical articles are based on scientific research?


Exercise: Search for evidence

Search in ABI/Inform or BSE:

  • Search for peer reviewed research articles to answer the following question: What is the long term effect of a hostile take-over on the financial performance of the acquired organization? Use the following search terms:

  • “hostile takeovers”, “financial performance”, “long term”

  • How many studies did you find?


Evidence-based practice

Fase 1: Het ontwikkelen van kritisch en wetenschappelijk denken dat leidt tot een professioneel-kritische attitude met betrekking tot organisatievraagstukken

Fase 2: Het kunnen formuleren van een expliciete vraag en op basis van deze vraag kunnen zoeken in online databases naar uitkomst van relevant wetenschappelijk onderzoek.

Fase 3: Het kritisch kunnen beoordelen van wetenschappelijke en organizational evidence (criticalappraisal)

Fase 4: Uitkomst van wetenschappelijk onderzoek kunnen toepassen in de eigen beroepspraktijk (application of science)


Research designs

Which design for which question?


What is the best design
What is the best design?

  • Randomized controlled study?

  • Grounded theory approach?

  • Cohort / panel study?

  • Qualitative field research?

  • Longitudinal study?

  • Post-test only study?

  • Survey?

  • Action research?

  • Case study?



What is the best design1
What is the best design?

quants vsquallies, positivists vs post structuralist, etc



Effect vs Non-effect


Types of questions

Does it work?

Does it work better than ....?

Does it have an effect on ....?

What is the success factor for ....?

What is required to make it work ...?

Will it do more good than harm?

Effect


Types of questions: non-effect

Needs: What do people want or need?

Attitude: What do people think or feel?

Experience: What are peoples’ experiences?

Prevalence: How many / often do people / organizations ...?

Procedure: How can we implement ...?

Process: How does it work?

Explanation: Why does it work?

Economics: How much does it cost?



Internal validity
Internal validity

internal validity = indicates to what extent the results of the research may be biased and is thus a comment on the degree to which alternative explanations for the outcome found are possible.


Causal relations

We are pattern seeking primates:

we are predisposed to see order and causal relations in the world


Causality
Causality

effect size

before and after measurement

randomization, blinding, control group, measurements

Considerations for research:

Are the "cause" and the "effect” related?

Does the "cause" precede the "effect" in time?

Are there no plausible alternative explanations for the observed effect?


Bias & Confounding

Research shows:

Shoe size > quality of handwriting

Smoking youngsters > better lung function





But 1: feasibility types of research designs,

Best research design?


But 1: feasibility types of research designs,


Step 3: Critical types of research designs, appraisal of studies


Intermezzo types of research designs,

How to read a research article?


Critical types of research designs, appraisal: quick and dirty

Is the study design appropriate to the stated aims?

Are the measurements likely to be valid and reliable?

Was there a relevant effect size?

Is the outcome (population, type of organization) generalizable to your situation?


Levels of internal validity types of research designs,

Were there enough subjects in the study?

Was a control group used?

Were the subjects randomly assigned?

Was a pretest used?

Was the study started prior to the intervention or event?

Was the outcome measured in an objective and reliable way?

6x yes = very high (A)

5x yes = high (A)

4-3x yes = limited (B)

2x yes = low (C)

1-0x yes = very low (D)


Appraisal types of research designs,

Critical appraisal questionnaires

www.cebma.org/ebp-tools


CAT: Critically Appraised Topic types of research designs,


CAT: types of research designs, Critically Appraised Topic

A critically appraised topic (or CAT) is a structured, short (3 pages max) summary of evidence on a topic of interest, usually focused around a practical problem or question. A CAT is like a “quick and dirty” version of a systematic review, summarizing the best available research evidence on a topic. Usually more than one study is included in a CAT.


CAT: structure types of research designs,

  • Background / context

  • Question (PICOC)

  • Search strategy

  • Results / evidence summary

  • Findings

  • Limitations

  • Recommendation


CAT-walk types of research designs,


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