Evidence-based decision-making in healthcare: exploring the issues though the lens of complex, adaptive systems theory.

Abstract

Browman, Snider and Ellis have articulated several reasons as to why and how managers should address the implementation of evidence-based decision-making (EBDM) in healthcare. While their observations are acknowledged to be from the unique perspective of an oncology setting, this is a timely and welcome lead article with significance in other settings. The authors invite opinions on transferability, thus forming the basis of this commentary. In response, this commentary offers a number of supportive and differing views. Complex, adaptive systems (CAS) theory is first addressed as an appropriate lens to reframe our conceptualization of the health system. Then, in contrast to negotiation, dialogue through participatory planning and decision-making is introduced. Evidence-based decision-making (EBDM) and knowledge translation (KT) are expanded upon in the context of CAS and participatory environments. Finally, concrete suggestions are offered on how to structure multiple-stakeholder involvement in the decision-making process, including the growing role of consumers in the new complex, adaptive systems reality of healthcare.