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Why evidence-based practice probably isn’t worth it…

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The evidence-based practice problem…

There is a big problem with evidence-based practice and why evidence-based practice isn’t worth it for most people…

As a pedlar of evidence based practice this post hasn’t been an easy one to write but after years of work in this area, and having a service based around evidence based practice, I have come to a conclusion: There is a really big evidence based practice problem that people outside of health and technology haven’t acknowledged.

In short there is a big problem with evidence-based practice.

People don’t want evidence-based practice

The problem with evidence based practice is that outside of areas like health care and aviation / technology is that most people in organisations don’t care about having research evidence for almost anything they do. That doesn’t mean they are not interesting in research but they are just not that interested in using the research to change how they do things – period.

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Evidence-based practice is a bit of a fail

Ok so lets look at what people at the top of the EBP tree say. Some recognise the problem…

Professor Rob Briner -Professor of Organizational Psychology at Queen Mary University London has a hobby horse and that is that almost every conference he attends is populated by evidence-based practice converts, people with skin the the game. People like researchers, or organisational development professionals or academics or practitioners turned academics.

Very few conferences have significant numbers of managers or workers from the ‘shop floor’ or operations’.

Attendance at such events and engagement generally appears to be largely confined to the academically minded converts outside of health and technology.

So why?

Considering the point of EBP is to engage operational people in organisations, to bring the research to them to help them make better decisions and work better, this appear to be a bit of a fail.

To underline that have a look at this…

I posted this: https://www.linkedin.com/pulse/6-important-factors-ensure-change-success-david-wilkinson on LinkedIn

At this moment in time to post has had 1 like, 2 comments and 1 share. Ok not great figures.

The first comment was this:

As you can see, not exactly a ringing endorsement for evidence based practice!

… and it got more likes than my original post!!

So who does engage with EBP?

Well largely, but not wholly occupations that have close ties with academia. I lecture in the Medical Sciences Division at the University of Oxford and a fair bit of my teaching is conducted in the hospitals in and around Oxford.

The professors and many of the lecturers are mainly, but not wholly, practicing medics. The University and the hospital, particularly the John Radcliffe or JR is actually part of the Oxford University Hospitals group. The same applies at the other university in Oxford, Oxford Brookes University that looks after nursing which is also heavily evidence-based.

Close academic – practice connection – really close

In fact they are so closely allied that it is impossible to distinguish between the academic side and the practice side. This I believe is an important aspect of this. The practitioners are the researchers and teachers and the researchers and teachers are often practitioners to ex-practitioners. It is hard to slide a sheet of paper between the two.

My lectures and session are in the operational context. My students are often on duty. They are doing the do, as they say. The people I teach are the next batch of lecturers and researchers, but they are the practitioners. Little separation.

Now this doesn’t mean that we don’t have partitioners who don’t teach and we don’t have researchers and lecturers who don’t practice. We do. Lots in fact.

But, and this is important –

The teachers and researchers are embedded in the culture of practice

and

the practitioners and operational staff are embedded in a culture of evidence and research.

So is it just a question of culture?

Well there is something else…

So what about the sectors, industries and organisations where EBP isn’t taking off?

Part of the the problem in the areas, sectors, industries and organisations where EBP isn’t taking off is this…

Who cares about using evidence for anything?

Largely, outside a few industries, organisations and the odd zealous individual or group, people don’t give a flying fig about evidence based-practice, what it means or even what it is about.

The majority of people in organisations are getting on with it and to be honest, just don’t need something else to make things harder or more complicated.

I can feel the evidence-based practioners shouting “But, but, but….” about now. So look at the evidence. Are the people in your organisation battering your door down chattering with excitement saying things like “please give us more about evidence-based practice” or “OMG I am just desperate for some more evidence about this”. Well? Need more evidence ?

Search volumes

Ok let’s look at some search volumes for evidence-based practice. Here we turn to some data from google. Here are the search trends for some topics…

Evidence-Based Practice

This is the search trend data for the term evidence-based practice over the last 5 years:

looks reasonably health. If anything there has been a slight decrease.

Lets widen the search to see how many more searches are being made…

Evidence-Based

Here is a comparison between the term evidence-based and evidence-based practice.

as we would expect with a broader term, higher search volumes. Oh the big dips are Christmas by the way… which says something about who is doing all the searching. More of this later.

The search for research

So lets see. I suppose this whole EBP thing is part of the search for research. So lets add research to the search volumes and see what happens…

As we might expect with something as broad as the term ‘research’ it has even higher reach volumes. However something interesting has happened – the term ‘evidence based practice’ disappears comparatively and the term ‘evidence-based’ almost flatlines. EBP really is a bit of a backwater compared to the idea of research.

So lets try to add a bit more perspective

Management is searched for more than research and way more than EBP

And the weather is a lot more interesting than research and as for evidence-based practice is concerned…

And as for porn…

…no competition!

Yup people are a million more times interested in porn than Evidence-based evidence. People just don’t give a monkeys toss about evidence-based practice, or you or what you are doing. When the weather is more interesting than what you are trying to do you have a problem….

But why? Well here is a clue…

So I thought I wonder what is more popular than the weather, more popular than things like Miley Cyrus, Donald Trump, the news and yes even more popular than sex and porn?

It’s this….

How to

People want to know how to do things… practical things.

Eh?

But at the bottom line isn’t evidence-based practice about how to do stuff?

Yes.

So what’s the disconnect?

Wrong language – wrong planet

Because you are talking the wrong language. In fact you are not just talking a different language to normal people, organisations, you are a different species on a different planet, in a different universe… and guess what.

Talking louder isn’t going to fix this one.

Let me show you something…. let me show you how bad this is…

See this?

So before I start on this let me first make an apology…. to Rob Briner. What you see here is a symptom of the cause of a lack of engagement.

Ok so let me start by saying I am not critiquing Rob or his message. I actually agree with most (not all) of what he says. Hey this is academia. Its all about the argument..

I get this in terms of rigour. It’s not without it’s problems – more of that later… but this roughly represents state of rigour in EBP.

But compared to porn and the weather it’s a bit freaking boring… no actually it’s a lot freaking boring unless you are an active researcher

and that is part of the problem – but before I advance this lets look at something…

The point Rob makes with this is that the lower we go down the hierarchy we go the more bias… well thats not quite true actually its an increased chance or risk of bias.

As we go up the hierarchy the better the chance or risk of finding the factors involved in causality also increases:

Ok all good yes?

So why is this a pyramid? Why is there more of the opinion anecdotes etc and fewer systematic reviews?

Well a couple of reasons…

Research dependencies

The first thing is that the research at the top depends on the stuff at the bottom.

You cant do a systematic review if there isn’t anything to review. Research works up the hierarchy, So, someone notices something and says thats odd or thats interesting and and mention it to someone else. They do a case study or write a blog. That gets picked up by someone doing research who says lets see what evidence there is for this and so on up the ladder.

In effect the things at the top DEPEND on the flow up the hierarchy from below them. As I said you cant have a systematic review if you haven’t got anything to review. So look at this…

How people make decisions at work

This comes from the CIPD HR Outlook Winter 2016/17 Report and is the result of a survey of 629 senior HR professionals and looks at how frequently they use what source of evidence when making business decisions.

80% of operational decision-making

All of these …. 80% of this chart are the very things that are on the very bottom rung of the Briner’s Hierarchy of evidence.

Research based decisions

And then you look at the numbers of people using these…

The figures tell a powerful story…

The figures speak for themselves…

At the bottom 22% using research always or often and

at the top 77% are using personal experience always or often

Its not even close…

Intuition beats evidence-based practice into a cocked hat…

Even intuition gets a better press than research!

But why? Are these uneducated, ignorant people?

I don’t think so. Many will have degrees and higher degrees like a Masters. Remember this survey was with managers and leaders….

It’s not a lack of education…

But I think it may be something else…

The world’s oldest profession

The world’s oldest profession…. and it’s not what you are thinking…

It’s the biggest industry on earth – bar non.

Story telling

Every book,

every film,

every news item,

and just about every Facebook post and every tweet is a story.

Social media are all about stories…

We live in a world of anecdotes and stories

What do you notice at the bottom?

Stories…

We as humans are preprogrammed to tell and listen to stories. You probably spend more time every single day of your life day listening to, creating and telling stories than all the other activities put together.

So why are we surprised that this is the number 1 source of evidence for work based decisions?

So if we want to get people interested in Evidence Based Practice hitting people over the head, telling them their evidence is crap, or that there is no evidence for what they are doing isn’t really going to win many friends or influence them…….,

maybe just maybe we should be flipping this on its head…

Its a funnel. A funnel of engagement. In the entrepreneurial side of my world there are things called marketing funnels…

Awareness, interest, consideration, intent, evaluation, purchase… all that has to happen before anyone will buy your product or

idea

People aren’t going to buy Evidence based practice until they are convinced it will solve their problems

But and its a BIG but….. You are not selling evidence based-practice though… remember this?

You are better off talking about porn or the weather rather than evidence-based anything…

PEOPLE AREN’T INTERESTED in EBP!

So don’t even try to sell it. There is no point….

…at first at least.

But we do know what they want,

what they really really want…

…inform business decisions…

Even more than porn and the weather…

Stuff like… How to make good decisions!

STOP beating people up and for the love of …

STOP selling Evidence-Based Practice

Use these…

use stories, case studies and anecdotes to capture people.

Get their interest first.

Tell stories, capture interest, stop being stuck up about systematic reviews, this method or that method… thats for later…

Research methods for most people

is boring

and

most people don’t care!

You ain’t going to capture anyone like that.

Thats for the people who buy evidence-based practice…

but before then…

go out and have some fun,

slay a few dragons,

help people to do stuff bit by bit.

Slowly slowly draw people in.

That’s it! I hope this has been interesting but more than anything I hope it has sold the bottom of the hierarchy, the vital importance of story telling, anecdotes and case studies in selling Evidence-Based Practice.