Abstract
The healthcare industry is a complex dynamic system, unlike any other industry. While evidence-based practice (EBP) is a well-defined approach within healthcare, evidence-based management (EBMgt) has yet to garner widespread acceptance from healthcare managers. This research study explores how frontline healthcare managers use evidence-based management by understanding what evidence they value and how they use evidence. This study also explores the skills and behaviours frontline healthcare managers require to implement evidence-based management into their decision-making and how they learn them. The context for this study is the Victorian Healthcare system in Australia, represented by metropolitan, regional, and rural health services.
Drawing on a constructivist paradigm, this study utilises ethnographic and autoethnographic methodologies allowing for the exploration of multiple realities. Mixed methods ensure that the research captures a broad range of the lived experience of frontline healthcare managers in the Victorian health system. A survey of 51 frontline managers used descriptive and explanatory questions to explore healthcare managers' characteristics, knowledge and use of evidence-based practice, evidence-based management, and change management practices, along with their perceptions of the skills and knowledge required to implement change successfully. Semi-structured interviews with eleven (11) frontline managers, including myself, expanded on the insights from the literature review and the survey findings. Given that the timing of the project coincided with the COVID-19 pandemic, its impact on leading change within the Victorian Health system was also explored.
This thesis highlights several insights into how frontline healthcare managers use EBMgt. While it has been noted in previous research that healthcare managers are a homogenous group with professional differences that affects how they use and value evidence. This research found that participants brought their prior use of clinical evidence into their clinical management decisions. However, only managers with management qualifications demonstrated an advanced understanding of management research. Most participants valued their prior experience as their primary evidence source, particularly when they had limited time and a rapid response was required for clinical and managerial change. After critical analysis of the thematic and narrative analysis, managerial practice wisdom was identified as the type of evidence experienced managers use when they combine their prior experience with experiential learning, reflection, and reflexivity. This research study provided insight into the journey of frontline healthcare managers in Victoria, who are often described as ill-prepared for their first role in management and are frequently recruited because of their clinical skills rather than their management experience. This research found several types of frontline managers, each with their own story and experiences. However, they all described little to no training or supervision at the start or throughout their career. This is in stark contrast to how healthcare trains and upskill clinicians.
This thesis introduces the Managerial Practice Wisdom Framework (MPWF), which provides a framework for how managers learn from their experiences, training, and education to develop managerial practice wisdom. Using an organisational learning lens, it proposes that managers not only learn by their own experiences, but they require the socialisation of information and shared experiences to embed new information into evidence. This framework can start the conversation on how healthcare organisations can develop processes that support managers so that their managerial practice wisdom can become as valuable to healthcare organisations as clinical practice wisdom.
This thesis also contributes to our understanding of who Victoria’s frontline healthcare managers are, how they use EBMgt, and implement change. Several recommendations are made that will assist the healthcare industry in meeting future healthcare challenges.
Drawing on a constructivist paradigm, this study utilises ethnographic and autoethnographic methodologies allowing for the exploration of multiple realities. Mixed methods ensure that the research captures a broad range of the lived experience of frontline healthcare managers in the Victorian health system. A survey of 51 frontline managers used descriptive and explanatory questions to explore healthcare managers' characteristics, knowledge and use of evidence-based practice, evidence-based management, and change management practices, along with their perceptions of the skills and knowledge required to implement change successfully. Semi-structured interviews with eleven (11) frontline managers, including myself, expanded on the insights from the literature review and the survey findings. Given that the timing of the project coincided with the COVID-19 pandemic, its impact on leading change within the Victorian Health system was also explored.
This thesis highlights several insights into how frontline healthcare managers use EBMgt. While it has been noted in previous research that healthcare managers are a homogenous group with professional differences that affects how they use and value evidence. This research found that participants brought their prior use of clinical evidence into their clinical management decisions. However, only managers with management qualifications demonstrated an advanced understanding of management research. Most participants valued their prior experience as their primary evidence source, particularly when they had limited time and a rapid response was required for clinical and managerial change. After critical analysis of the thematic and narrative analysis, managerial practice wisdom was identified as the type of evidence experienced managers use when they combine their prior experience with experiential learning, reflection, and reflexivity. This research study provided insight into the journey of frontline healthcare managers in Victoria, who are often described as ill-prepared for their first role in management and are frequently recruited because of their clinical skills rather than their management experience. This research found several types of frontline managers, each with their own story and experiences. However, they all described little to no training or supervision at the start or throughout their career. This is in stark contrast to how healthcare trains and upskill clinicians.
This thesis introduces the Managerial Practice Wisdom Framework (MPWF), which provides a framework for how managers learn from their experiences, training, and education to develop managerial practice wisdom. Using an organisational learning lens, it proposes that managers not only learn by their own experiences, but they require the socialisation of information and shared experiences to embed new information into evidence. This framework can start the conversation on how healthcare organisations can develop processes that support managers so that their managerial practice wisdom can become as valuable to healthcare organisations as clinical practice wisdom.
This thesis also contributes to our understanding of who Victoria’s frontline healthcare managers are, how they use EBMgt, and implement change. Several recommendations are made that will assist the healthcare industry in meeting future healthcare challenges.
| Original language | English |
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| Qualification | Doctor of Business Administration |
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| Place of Publication | Australia |
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| Publication status | Published - 30 Oct 2023 |