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Evidence as a tool for managerial action: a complex adaptive systems view.

Evidence-based management (EBM) is based on the idea that managers should adopt practices that scientific inquiry has shown to be effective. The evidence produced from scientific inquiry contributes to the body of knowledge that informs the management practices advocated by EBM. This evidence is generally seen as a solution for a problem faced by managers. Arndt and Bigelow (2009) pointed to three underlying assumptions of EBM: (a) Decisions based on evidence will yield anticipated results, (b) results from EBM will be generalizable across organizations, and (c) evidence is objective and independent of context. Arndt and Bigelow showed that these assumptions do not hold for modern health care organizations because unexpected outcomes are frequent, initial conditions are unknowable, and locality is paramount. Following this logic, it is then reasonable to say that evidence generated from management studies may not, in fact, provide solutions to the problems that managers face. Critical reflection on how managers of health care organizations should use evidence from management studies is needed. The solution to the challenge of how to use evidence from management research in health care is not to simply throw it out and rely on logical analysis unsupported by empirical evidence or on myth or superstition. Rather, the solution exists in our capacity to think carefully about the fundamental nature of available research evidence and the fundamental nature of health care organizations and in our ability to help health care managers take locally relevant, evidence-informed action. In this essay, we extend the argument made by Arndt and Bigelow (2009) by proposing an alternative way to think about the evidence generated by management research. EBM is generally conceptualized as a way to apply a standard course of action to a common, presumably recurring problem. Complex adaptive systems theory leads us to believe that, regardless of the number of apparent similarities across systems, small or unrecognized differences in the relationships among variables, unknowable unintended consequences of action, and seemingly inconsequential differences in initial conditions can make standard responses to a common problem ineffective. We suggest that rather than thinking about evidence as a solution to be applied to a common problem, managers in health care organizations should think about evidence as a tool for locally relevant managerial action. Specifically, evidence should be used as a seed for informed conversation, a guide for local action, and a strategy for learning.