EVIDENCE‐BASED MANAGEMENT: THE VERY IDEA
| Author | MARK LEARMONTH,NANCY HARDING |
| Published date | 01 June 2006 |
| Date | 01 June 2006 |
| DOI | http://doi.org/10.1111/j.1467-9299.2006.00001.x |
ARTICLES
EVIDENCE-BASED MANAGEMENT:
THE VERY IDEA
MARK LEARMONTH AND NANCY HARDING
This essay critically evaluates the recent phenomenon of ‘ evidence-based manage-
ment ’ in public services that is especially prominent in health care. We suggest that
the current approach, broadly informed by evidence-based health care, is misguided
given the deeply contested nature of ‘ evidence ’ within the discipline of management
studies. We argue that its growing popularity in spite of the theoretical problems it
faces can be understood primarily as a function of the interests served by the uni-
versalization of certain forms of managerialist ‘ evidence ’ rather than any contribu-
tion to organizational effectiveness. Indeed, in a reading informed by the work of
French geographer Henri Lefebvre, we suggest that in the long term the project
is likely to inhibit rather than encourage a fuller understanding of the nature of
public services. We conclude with a call for forms of organizational research that the
current preoccupations of the evidence-based project marginalize if not write out
altogether.
INTRODUCTION
Today, it is widely accepted in Western health services – both by govern-
ments and at local level – that evidence enhances the rationality of clinical
decisions and that clinical decisions should therefore be made on the basis
of ‘ the conscientious, explicit and judicious use of current best evidence ’
( Sackett et al. 1996 ). Raine has rightly characterized evidence-based practices
as the current ‘ zeitgeist in health care ’ (1998 p. 251) in that, despite prob-
lematizing voices (for example, Wood et al. 1998; Green 2000; Trinder and
Reynolds 2000; McLaughlin 2001, 2004; Traynor 2000, 2004; Wood and Ferlie
Mark Learmonth is in the Nottingham University Business School, University of Nottingham. Nancy
Harding is in the Institute of Health Sciences and Public Health Research, University of Leeds.
Public Administration Vol. 84, No. 2, 2006 (245–266)
© Blackwell Publishing Ltd. 2006, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street,
Malden, MA 02148, USA.
246 MARK LEARMONTH AND NANCY HARDING
© Blackwell Publishing Ltd. 2006 Public Administration Vol. 84, No. 2, 2006 (245–266)
2003; Lather 2004 ), mainstream debate and government policy have come to
focus upon the means by which clinical decision making can incorporate
scientifi c evidence, the aim in itself having become almost axiomatic.
In parallel with this development, evidence-based approaches are increas-
ingly being commended for policy and management decision making in the
public sector – especially (though not exclusively) in health services ( Hewison
1997; Axelsson 1998; Homa 1998 ; Øvretveit 1998; Leicester 1999; Kovner
et al. 2000; Iles and Sutherland 2001; Walshe and Rundall 2001; Stewart 2002 ).
Just as evidence-based medicine is now offi cially sanctioned as the best way
to reduce uncertainty in clinical practice, so the proponents of evidence-
based management believe that evidence about organizational phenomena
can reduce managers ’ uncertainties. As Stewart put it ‘ evidence-based med-
icine has led to … a way of thinking that can and should be applied more
generally in management ’ (2002, p. 17). Indeed, in the UK, a government
agency called the NHS Service Delivery and Organisation ( sic ) (SDO)
Programme has existed since 2000, and in 2003/2004 it spent just short of
£3.7 million (SDO 2004, p. 32) to provide: ‘ a national research programme
… to consolidate and develop the evidence base on the organisation ( sic ),
management and delivery of health care services ’ (SDO 2004, p. 6).
Traditionally, medical research has insisted upon a hierarchy of evidence
in which the randomized control trial is pre-eminent ( Harrison 1998 );
evidence-based management, in contrast, is methodologically and episte-
mologically considerably more eclectic. So while quantitative methods are
used, qualitative methods driven by non-positivistic orientations are also
signifi cant if not dominant in the fi eld ( Ferlie et al. 2001; Iles and Sutherland
2001; Murphy and Dingwall 2003 ). Furthermore, though evidence-based
management still seems to be the most popular formulation, terms such as
‘ evidence-informed decision making ’ are also used, presumably indicating
caution about the capacity of evidence to be the sole basis of management
decision making given the importance in real life of pragmatic and other
considerations.
Nevertheless, the basic doctrine of evidence-based management remains
one appropriated from evidence-based health care: that a consideration of
evidence will increase the rationality and thus the effectiveness of managers ’
decisions. Both in medicine and management, approaches that base practice
on ‘ evidence ’ assume a science that is based on laws that can be elucidated
for the benefi t of all ( Ozcan and Smith 1998; Wood and Ferlie 2003 ); and in
both, ‘ the evidence ’ tends to be presented as if it were independent of the
social circumstances of its production.
However, inattention to the socially situated position of management
knowledge has meant that the proponents of evidence-based management
typically take for granted certain institutionalized features of organizational
life ( Meyer and Rowan 1977 ). In particular, the domination of organizations
by management elites and the idea of organizations as manageable entities
are both unexamined as potentially problematical questions and debates.
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