Point article.

POINT ARTICLE

The last decade has seen considerable growth in the field of evidence-based medicine (Ellrodt et al., 1997). The concept is simple. Physicians should base their decisions on the findings of scientific studies, rather than on anecdotal experience. This certainly makes good sense. It follows then, that the use of scientific evidence should make sense for managers as well (Walshe & Rundall, 2001). In the last few years there has been a movement that proposes broad application of the concept of evidence-based management to health care organizations (Axelsson, 1998; Kovner, Elton & Billings, 2000). More recently there has started to be a focus on the use of an evidence-based approach in the area of health care financial management (Finkler, Henley & Ward, 2003).

It is certainly unlikely that anyone would want their medical treatment to be based on anything less than the best scientific information. Financial managers would likely argue that they have also tried to base their decisions on the best available information. For example, they have been strong proponents of the use of benchmarking so that decisions can be based on best practices. However, the limitation of benchmarking is that it embraces the goal of evidence-based medicine but not necessarily the technique. Specifically, it searches for best existing practices without requiring that those practices be validated by a formal research study. Instead, benchmarking is based on anecdote, rumor, and in the best case, careful review of the processes used by an organization with the perceived best practices.

It has been argued that health care financial managers have failed to either demand or generate sufficient evidence to support their decisions, and even when evidence is available, health care financial managers have often failed to use such evidence (Finkler & Ward, 2003). Part of the problem is that there are barriers to the introduction of evidence-based financial management in health care. These barriers are largely the result of culture (management culture is different from clinical culture). However, they also result from a failure on the part of health care financial management educators to focus on this issue in their classes (Finkler 2003). If educators don't instill the importance of evidence to health care financial management students, it should not be surprising to see that when they become managers they don't commission research or even employ available research results to assist in their decisions.

I encourage educators to teach health administration majors about the goals of research and about the different types of research methods. What are we waiting for? If educators provide more examples of evidence in their classes and give their students experience gathering and using evidence, those students are likely to see the potential benefit of research findings. In turn, as they become managers they are more likely to call for, use, and even fund evidence-based financial management research.

I would not argue that there has been no work published with the goal of improving financial management decisions made by health care organizations. Journals such as this one, and also Healthcare Financial Management and the Journal of Health Care Finance, among others, do publish such articles. And some of the articles are rigorous research studies that managers can employ in making effective decisions. However, often articles are descriptive. They tend to provide a description and the potential benefits of a technique, rather than providing any rigorous findings that support the notion that the technique actually does improve results. Even when good evidence exists, we do not know much about how it is used. When articles are published that report on research findings, it is rare to see any follow-up research to tell us if anyone employed the results of the study in making their decisions. How do health care financial managers react when evidence is available? We do not know.

Ideally, researchers would first do explorative research to find out the questions that healthcare managers want answered. Then they would raise the funds to conduct the research and carry it out. The results would be published upon the conclusion of the research. And managers would actually search out the study results and consider them prior to making their decisions. Finally, some evaluation would be done ex post, to try to determine whether the organizations that make decisions based on evidence rather than anecdote or theoretical calculations have better outcomes.

Ultimately, the goal of generating evidence is to enable decisions that will improve the financial results of the organization, while either maintaining or improving the quality of care provided. I hope that this brief exploration of the topic of evidencebased financial management provides a foundation to initiate discussion, debate, and ultimately action on the part of healthcare financial managers and researchers.

REFERENCES

Axelsson, R. (1998). Toward an evidence-based health care management. International Journal of Health Planning and Management, Oct.-Dec., 13(4), 307-17.

Ellrodt, G., Cook, D.J., Lee, J., Cho, M., Hunt, D., & Weingarten, S. (1997). Evidence-based disease management. Journal of the American Medical Association, Nov. 26, 278(20), 1687-92.

Finkler, S.A. (2003). Teaching future healthcare financial managers to use evidence. Journal of Health Administration Education, Fall 20(4), 243-61.

Finkler, S.A., Henley, R.J., & Ward, D.M. (2003). Evidence based financial management. Healthcare Financial Management, Oct., 64-8.

Finkler, S.A., & Ward, D.M. (2003). The case for evidence-based management research for the control of hospital costs. Health Care Management Review, Fall 28(4), 348-65.

Kovner, A.R., Elton, J.J., & Billings, J.D. (2000). Evidence-based management. Frontiers of Health Services Management, Summer 16(4), 3-24.

Walshe, K. & Rundall, T.G. (2001). Evidence-based management: from theory to practice in health care. The Milbank Quarterly, 79(3), 429-57.

Steven A. Finkler is a member of the Executive Committee of the International Society for Research in Healthcare Financial Management, and is a member of the Editorial Board for RESEARCH IH HEALTHCARE FINANCIAL MANAGEMENT.