Letters

As with evidence-based medicine (EBM), evidence-based management is an idea long ignored by those who profess to practise it.

Rosemary Stewart's article ('More art than science', pages 28-29, 26 March) is a welcome introduction to the subject.

She rightly sees the obstacles facing evidence-based management as those facing EBM. Others include:

a cultural divide between managers/clinicians, researchers, and educators;

managers'/clinicians' view of a great deal of research as esoteric and irrelevant to their everyday activities and experience;

ineffective communication both locally and nationally;

lack of incentives to overcome professional boundaries.

For management decision-making to emulate EBM, it will mean fostering a culture receptive to good quality management research. But it needs more than one senior manager role model, and chief executives should take a more proactive role.

I disagree with Dr Stewart on other points. She says medicine is a profession with a long training. How many managers who have undertaken the NHS management training scheme, diplomas, degrees and MBAs while working and gaining experience would say their profession does not require similar rigorous training?

Her point that doctors are taught to look for evidence in their diagnoses and to learn accepted methods of treatment, and that this is not relevant to managers, is patently unacceptable. If management methods are not backed by evidence supporting effective practice, they will probably fail at the first hurdle.

And it is disingenuous not to include nursing and professions allied to medicine, whose practice has also been likened to an art rather than a science.

Evidence-based management should be promoted throughout the NHS by a management-effectiveness initiative involving national guidelines for practice on recruitment, retention, performance management systems, change management, stress, dealing with absence, and waiting lists. The research is there, but like clinical audit, the difficulty is using it to change practice.

With the drive to reduce NHS management, it is time managers had access to the best available evidence for making decisions. The EBM agenda is partly to cut costs; the savings from evidence based management could be huge.

Sean Crawford, Clinical audit facilitator, Camden and Islington Community Health Services trust.