Dissertation - Doctoral Evidence Based Strategic Decision Making in Ontario Public Hospitals


Melanie Kazman Kohn


Context: A relatively recent focus on evidence based management has been influenced strongly by evidence based medicine. Healthcare administrators are encouraged to utilize similar principles to optimize their decision making. There are no known studies that address whether or not and how evidence is used by healthcare administrators in decision making practice and process.

Objectives: This study explores how evidence is conceptualized by public hospital executives and whether or not, and how, evidence is brought to bear on strategic decision making.

Design: The study undertook a qualitative design, using a grounded theory approach. The focus was to uncover how evidence is conceptualized by decision makers, whether or not and how evidence as defined is brought to bear, and under what conditions and why evidence is brought to bear. The study included four public hospitals in the Greater Toronto Area, two academic health sciences centres and two community teaching hospitals. Hospital CEOs were asked to identify three strategic decisions (one clinical expansion, one partnership, and one decision on prioritizing quality improvement). Interviews were conducted with 19 healthcare leaders and decision makers, and content analysis was undertaken for 64 supporting documents.

Results: Strategic decision makers in this study bring an amalgam of evidence to bear on strategic decisions. Evidence comes from sources internal and external to the organization, and includes a series of types of evidence ranging from published research to local business evidence. The reasons for bringing evidence to bear are highly intertwined. Evidence was sought, developed, and brought to bear on decisions in a formalized manner, and was used in concert with conditions internal and external to the organization, and informed by the decision maker characteristics.

Conclusion: Evidence plays a prominent role in strategic decision making. Strategic decisions were supported by processes requiring evidence to be brought to bear.


Whitney Berta