De presentatie wordt gedownload. Even geduld aub

De presentatie wordt gedownload. Even geduld aub

Evidence-Based Practice Lunchbijeenkomst 14 maart 2013.

Verwante presentaties


Presentatie over: "Evidence-Based Practice Lunchbijeenkomst 14 maart 2013."— Transcript van de presentatie:

1 Evidence-Based Practice Lunchbijeenkomst 14 maart 2013

2

3 HBOUniversiteit Post Grad (E)MBA Business Schools

4 1. Wat moet een student in de praktijk straks kunnen: - zelf onderzoek doen? - onderzoek kunnen beoordelen + toepassen? - onderzoek kunnen beoordelen + toepassen? 2.Wat betekent dat voor het curriculum? 3.Wat betekent dat voor de accreditatie? Aanleiding

5 “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.” HBO standaard (2009)

6 Evidence-Based Practice ?

7  Wat is het?  Waar komt het vandaan?  Hoe ziet het er uit in een opleiding?  Hoe zit dat bij 4e jaars studenten?

8 Evidence based practice: Wat is het?

9 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

10 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

11 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

12 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'.

13 Professional expertise and judgement Best available organizational evidence Stakeholders’ values and concerns Best available scientific evidence Evidence-based decision Evidence based practice

14 Evidence based practice: Waar komt het vandaan?

15  “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” What field is this?

16 McMaster University Medical School, Canada Medicine: Founding fathers David Sackett Gordon Guyatt

17 How it all started

18 if you’re hyperventilating breathe into a bag Problem I: persistent convictions

19 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 Problem I: persistent convictions

20 How 40,000 cardiologists can be wrong In the early 1980s newly introduced anti-arrhythmic drugs were found to be highly successful at suppressing arrhythmias. Not until a RCT was performed was it realized that, although these drugs suppressed arrhythmias, they actually increased mortality. By the time the results of this trial were published, at least 100,000 such patients had been taking these drugs.

21 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)

22  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 information

23  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

24 The 5 steps EBP 1. Formulate a focused question (Ask) 2. Search for the best available evidence (Acquire) 3. Critically appraise the evidence (Appraise) 4. Integrate the evidence with your professional expertise and apply (Apply) 5. Monitor the outcome (Assess) Zelf onderzoek doen?

25 Evidence-Based Practice 1991Medicine 1998Education 1999Social care, public policy 2000Nursing 2000Criminal justice ????Management?

26 Evidence based practice: Hoe ziet het er uit in de opleiding?

27 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 (critical appraisal) Fase 4: Uitkomst van wetenschappelijk onderzoek kunnen toepassen in de eigen beroepspraktijk (application of science) Evidence-based practice

28 Professional expertise and judgment Best available organizational evidence Stakeholders’ values and concerns Best available scientific evidence Evidence-based decision Evidence based practice

29 Waarom (wetenschappelijk) onderzoek?

30 Trust me, 20 years of experience

31 Bounded rationality

32 “The first principle is that you must not fool yourself - and you are the easiest person to fool”. Richard Feynman

33 Bounded rationality

34 Het feilbare brein System 1  Snel, actie  Intuitief, associatief  shortcuts & biasses System 2  Langzaam (lui!)  Rationeel  Nadenken

35 Systeem 1

36  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 Systeem 1: het feilbare brein

37 Het feilbare brein -Meningen -Assumpties (aannames) -Overtuigingen -Persoonlijke ervaringen Wetenschappelijk onderzoek -Feiten -Evidence: bewijs / aanwijzingen Waarom onderzoek? BIAS

38 1. Denkfouten 2. Informatiebronnen 3. Mythbusting 4. Assumpties Fase 1: Kritisch & wetenschappelijk denken

39 1. Seeing order in randomness 2. Confirmation bias 3. Small numbers fallacy 4. Outcome bias 5. Halo effect 6. Authority bias 7. Group think 7 Denkfouten (die u beter aan anderen kunt overlaten)

40  Een Type I fout of een vals positief: denken dat er een patroon / verband is terwijl dat er in het echt niet is.  Een Type II fout of een vals negatief: denken dat er geen patroon / verband is terwijl dat er in het echt wel is Dr. Michael Shermer (Director of the Skeptics Society) Seeing order in randomness

41  Een Type I fout of een vals positief: denken dat het geritsel in de bosjes een gevaarlijk roofdier is, terwijl het gewoon de wind is (goedkoop foutje) Het feilbare brein: patern recognition

42  Een Type II fout of een vals negatief: denken dat het geritsel in de bosjes gewoon de wind is, terwijl het een gevaarlijk roofdier is (duur foutje) Het feilbare brein: patern recognition

43 Het probleem met patroon herkenning: Het kritisch beoordelen of er sprake 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 om aan te nemen dat alle patronen echt zijn. Het feilbare brein: patern recognition

44  Een Type I fout of een vals positief: denken dat het geritsel in de bosjes een gevaarlijk roofdier is, terwijl het gewoon de wind is (goedkoop foutje) DEFAULT  Een Type II fout of een vals negatief: denken dat het geritsel in de bosjes gewoon de wind is, terwijl het een gevaarlijk roofdier is (duur foutje) Het feilbare brein: patern recognition

45 Ook ervaren mensen en experts zien patronen en verbanden waar ze niet zijn. stress & lifestyle peptic ulcer Het feilbare brein: patern recognition

46 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. Oct 2005

47 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. Het feilbare brein: patern recognition (systeem 1 doet altijd mee!)

48 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 (critical appraisal) Fase 4: Uitkomst van wetenschappelijk onderzoek kunnen toepassen in de eigen beroepspraktijk (application of science) Evidence-based practice

49

50 5-step approach EBMgt is a 5-step approach 1.Formulate an answerable question (PICOC) 2.Search for the best available evidence 3.Critically appraise the quality of the found evidence 4.Integrate the evidence with managerial expertise and organizational concerns and apply 5.Monitor and evaluate the results

51 Formulate a focused question

52 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?

53  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? Foreground question?  Does team-building work?

54 P =Population I = Intervention or success factor C = Comparison O = Outcome C = Context Answerable question: PICOC

55 2. Finding the best available evidence

56 Searching evidence Searching evidence What do we search?

57 Current Information Overview of a subject General background Academic Information Statistical Information Theories about a subject What do we search? Company information

58 Peer reviewed journals

59 Searching evidence Searching evidence Where do we search?

60 Searching for evidence

61 Databases  ABI/INFORM  Business Source Elite  PsycINFO  Web of Knowledge  ERIC  Google Scholar

62 Searching for evidence

63 Searching evidence Searching evidence How do we search? Search Strategy

64 Two types of search strategies Search strategy Building blocks method Snowball method

65 Search strategy

66 Search in ABI/Inform: 1. How many articles has Stephen Covey published in peer reviewed journals? 2. How many of these articles are based on scientific research? 3. Are there articles (by other authors) that are critical of Covey’s 7 Habits? 4. How many of these critical articles are based on scientific research? Exercise: Search for evidence

67 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” “hostile takeovers”, “financial performance”, “long term” How many studies did you find? How many studies did you find? Exercise: Search for evidence

68 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 (critical appraisal) Fase 4: Uitkomst van wetenschappelijk onderzoek kunnen toepassen in de eigen beroepspraktijk (application of science) Evidence-based practice

69 Which design for which question? Research designs

70  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 design?

71 What is the BEST car?

72 What is the best design? quants vs quallies, positivists vs post structuralist, etc

73 on the research question

74 Effect vs Non-effect

75 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

76 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?

77 Internal validity

78 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. Internal validity

79

80 We are pattern seeking primates: we are predisposed to see order and causal relations in the world Causal relations

81 1.Are the "cause" and the "effect” related? 1.Does the "cause" precede the "effect" in time? 2.Are there no plausible alternative explanations for the observed effect? effect size effect size before and after measurement before and after measurement randomization, blinding, control group, measurements randomization, blinding, control group, measurements Considerations for research: Causality

82 Bias & Confounding Research shows: Shoe size > quality of handwriting Smoking youngsters > better lung function

83 Levels of internal validity Levels of internal validity

84 Explanation Which design for which question?

85 Different types of research questions require different types of research designs, but...

86 Best research design? But 1: feasibility

87

88 Step 3: Critical appraisal of studies

89 Intermezzo How to read a research article?

90 Critical 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?

91 Levels of internal validity 1.Were there enough subjects in the study? 2.Was a control group used? 3.Were the subjects randomly assigned? 4.Was a pretest used? 5.Was the study started prior to the intervention or event? 6.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)

92 Appraisal Critical appraisal questionnaires

93 CAT: Critically Appraised Topic

94 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.

95 CAT: structure 1) Background / context 2) Question (PICOC) 3) Search strategy 4) Results / evidence summary 5) Findings 6) Limitations 7) Recommendation

96 CAT-walk


Download ppt "Evidence-Based Practice Lunchbijeenkomst 14 maart 2013."

Verwante presentaties


Ads door Google