Evidence based decision making

All stakeholders are urged to pay more attention to the quality of evidence used and produced during the evaluation process in order to select appropriate evaluation methods. A 'theory of evidence for evaluation' is needed to better address this issue. This article discusses the relationships between the three main goals of evaluation (to learn, measure and understand) and the various types of evidence (evidence of presence, of difference-making, of mechanism) which are produced and/or used in the evaluation process. It argues for the need to clearly distinguish between this approach and that of levels of evidence, which is linked to data collection and processing methods (e.g. single case observations, difference methods, randomized controlled trials…). The analysis is illustrated by examples in the field of agro-environmental policymaking and farm advisory services.

The evidence-based decision-making (EBD) review service seeks to improve evidence, understanding and decision making in complex cases of neglect known to local authorities. The key findings are:

• The review can play a role in improving evidence, understanding and decision making. Helpful features include: the requirement to be evidence based; the challenge provided by an NSPCC social worker; increased time given to the family; the use of numerical scores and traffic light coded charts; and the focus on strengths as well as weaknesses.

• The review was not always used to improve evidence,
understanding and decision making. The social worker’s focus, capacity for critical reflection, writing skills, communication skills and workload influenced his or her ability to get the most out of the review. The impact of the EBD review could be limited when social workers already had good evidence and understanding prior to the review.

• The findings suggest a range of activities that the NSPCC could engage in to develop practice in assessment and decision making on neglect. These are: promoting use of the review; providing an assessment service; promoting a culture of challenge and a focus on long-term safety within social work practice; and campaigning for sufficient time to be spent on the assessment of neglect.

• This report describes the different ways in which the review was used and explains the reasons for this variation. It does not aim to quantify the ways in which the review’s scale tool was used. Nor does it aim to establish the impact of the review or the validity or reliability of the scale tool used in the review. The validity and reliability of the tool has been demonstrated elsewhere (Kirk, 2008; Kirk, 2012; Kirk and Martens, 2006; Pennel, 2008).

Objetivo: Comparar la efectividad del Modelo de Toma de Decisiones Gerenciales en Salud Basada en Evidencia con la del Modelo Conductista en el desarrollo de competencias para la integración de evidencia a la toma de decisiones estratégicas, en el contexto sanitario, en estudiantes del Postgrado en Gerencia de Servicios Asistenciales en Salud de la Universidad Católica Andrés Bello. Metodología: Se realizó un estudio experimental del tipo "preprueba-posprueba y grupo de control", en el que la variable independiente estuvo representada por el nivel de conocimiento en toma de decisiones y la dependiente por el grado de desarrollo de competencias para la integración de evidencia al proceso de toma de decisiones gerenciales en salud. A los tres grupos conformados (dos experimentales y uno control) se les administró un conjunto de cuatro instrumentos, a saber, una ficha de datos personales, un cuestionario sobre el Modelo Conductista, un cuestionario sobre el Modelo de Toma de Decisiones Gerenciales en Salud Basada en Evidencia y un instrumento de evaluación del grado de desarrollo de las mencionadas competencias. Dichos instrumentos se aplicaron antes y después de una intervención en la que se le proporcionó información amplia sobre el Modelo Conductista al grupo experimental "A" y sobre el Modelo de Toma de Decisiones Gerenciales en Salud Basada en Evidencia al "B". El análisis estadístico de los datos consistió en el establecimiento de la existencia o ausencia de diferencias estadísticamente significativas entre los promedios de las puntuaciones obtenidas por los grupos en los cuestionarios y en el instrumento de evaluación de competencias, primero en la preprueba y luego en la posprueba, así como en el establecimiento de la existencia o ausencia de tales diferencias entre los promedios de las puntuaciones obtenidas por cada grupo después de la intervención y los correspondientes a la preprueba, tanto en los cuestionarios como en los distintos bloques de planteamientos del instrumento de evaluación de competencias. Resultados: Antes de la intervención no hubo diferencias estadísticamente significativas entre los promedios de las puntuaciones obtenidas por los grupos en cada cuestionario y en el instrumento de evaluación de competencias, pero luego de dicha intervención sí se hallaron tales diferencias. Asimismo, en el cuestionario sobre el Modelo Conductista se encontraron diferencias entre el par de promedios de puntuaciones (posprueba-preprueba) del grupo "A", en tanto que en el cuestionario sobre el Modelo de Toma de Decisiones Gerenciales en Salud Basada en Evidencia se hallaron diferencias significativas entre el promedio de las puntuaciones obtenidas por el grupo experimental "B" en la posprueba y el correspondiente a su desempeño antes de la intervención. Finalmente, en los bloques de planteamientos del instrumento de evaluación de competencias solo se encontraron diferencias entre el par de promedios de puntuaciones (posprueba-preprueba) del grupo "B". Conclusiones: En la muestra de participantes de esta investigación, solo aquellos que incrementaron significativamente su nivel de conocimiento sobre el Modelo de Toma de Decisiones Gerenciales en Salud Basada en Evidencia lograron, al final de la misma, un mayor desarrollo de las competencias evaluadas. Sin embargo, se requiere de estudios con muestras más grandes y de mayor duración para corroborar estos resultados

The saying by Australia’s first saint - St Mary of the Cross MacKillop - “Never see a need without doing something about it” (1881) - underscores the crucial role of leadership in giving purpose to student achievement data and operationalising the use of such information for learning improvement.  If we accept that our role as educators is about improving student learning, it follows that the role, purpose and use of achievement data is instrumental in providing information to a wide range of stakeholders in support of such improvement.

Using findings from recent research, this article posits that the central element in exercising evidence-based leadership for moral agency is ‘moral potency’, which can impact on one’s willingness and perceived ability to act, as well as the capacity to make a real difference.  Here, the role of context is seen as a filter or barrier that can inhibit linking the moral purpose of what we believe about the value of such data, with the practical, and often competing, issues in operationalising the response.  In this sense, then, moral purpose may not automatically lead to moral action.

Recognising the impact of moral potency involves leadership practices that give an explicit, articulated and practical priority for student improvement, linking moral purpose, moral action and context to “never see a need without doing something about it”.

Objective – The primary objective was to examine online journal database usage statistics for a provincial ministry of health in the context of evidence based decision-making. In addition, the study highlights implementation of the Journal Access Centre (JAC) that is housed and powered by the Ontario Ministry of Health and Long-Term Care (MOHLTC) to inform health systems policy-making.
Methods – This was a prospective case study using descriptive analysis of the JAC usage statistics of journal articles from January 2009 to September 2013.
Results – JAC enables ministry employees to access approximately 12,000 journals with full-text articles. JAC usage statistics for the 2011-2012 calendar years demonstrate a steady level of activity in terms of searches, with monthly averages of 5,129. In 2009-2013, a total of 4,759 journal titles were accessed including 1,675 journals with full-text. Usage statistics demonstrate that the actual consumption was over 12,790 full-text downloaded articles or approximately 2,700 articles annually.
Conclusion – JAC’s steady level of activities, revealed by the study, reflects continuous demand for JAC services and products. It testifies that access to online journal databases has become part of routine government knowledge management processes. MOHLTC’s broad area of responsibilities with dynamically changing priorities translates into the diverse information needs of its employees and a large set of required journals. Usage statistics indicate that MOHLTC information needs cannot be mapped to a reasonably compact set of “core” journals with a subsequent subscription to those.

Available at: <https://journals.library.ualberta.ca/eblip/index.php/EBLIP/article/view/28052>.

In this article we call for a new approach to patient safety improvement, one based on the emerging field of evidence-based healthcare risk management (EBHRM). We explore EBHRM in the broader context of the evidence-based healthcare movement, assess the benefits and challenges that might arise in adopting an evidence-based approach, and make recommendations for meeting those challenges and realizing the benefits of a more scientific approach.

Basic research for this article was made using a holistic approach in order to analyze, critically and reflexively, the role that evidence-based clinical practice should play in health services management, within the framework of a new approach to strategic decision-making in the health context. Aspects were identified in which evidence constitutes a link between the provision of care and organizational performance, revealing the importance of the Evidence-Based Managerial Health Decision-Making Model as a methodological framework for the search for, construction, selection and evaluation of feasible alternatives, not only for solving complex problems but also for optimizing activities. Conclusions are that implementation of this model could have a positive impact on the entire health system and, ultimately, on the social macro system of which it is a part. However, this requires that managers and others responsible for strategic decision-making develop and strengthen specific skills for proper application of the model

Researchers and decision-makers have different views of what constitute evidence for decision-making and the value of the various forms of evidence (Sumner et al. 2011; Brownson et al. 2009; Lomas et al. 2005; Lewis 2007; Bowen and Zwi 2005). Researchers consider evidence to be findings from research studies (with differences of opinion among researchers about legitimate methodologies) (STEP UP Research Programme Consortium 2013), whereas decision-makers consider a range of research studies, along with monitoring and evaluation data, program reports, policy documents, community input, and professional experience as evidence. Availability of local evidence is important to national decision-makers.  Decision-makers tend to filter scientific evidence through other factors, including their beliefs about the issue and whether the evidence fits those beliefs and is useful (e.g. feasible, cost-effective, implementable, etc.); their values surrounding the issue; and on political, economic, and social constraints (Fisher et al. 1991; Cookson 2005; Kim 2006; Eyben 2013; DFID 2014).  The facilitating factors and barriers to evidence use have been consistent over time and are similar for family planning as for other health areas (Oliver et al. 2014; Hyder et al. 2010; Brambila et al. 2007; Simmons et al. 2007; WHO 2006; Almeida and Basolo 2006; Innvaer et al. 2002; Askew et al. 2002; Simmons et al. 2002; Trostle et al. 1999; Koenig and Whittaker 1991). Evidence use in decision-making can be influenced by the availability of relevant evidence; the extent of collaboration between researchers and decision-makers; the clarity of the presented evidence; the timeliness of the evidence; decision-maker and researcher skills; the strength or weakness of relationships between decision-makers and researchers; and the costs of implementing research findings. Continued challenges to evidence use in decision-making stem from differences in the contexts and reward structures under which researchers and policymakers work, particularly the different timescales of research and decision-making.

Esta investigación, desarrollada en el marco del plan de estudios del Postgrado en Gerencia de Servicios Asistenciales en Salud de la Universidad Católica Andrés Bello, entre septiembre de 2007 y abril de 2008, con el propósito de diseñar un modelo de toma de decisiones gerenciales que incorpore aspectos metodológicos de la Práctica Clínica Basada en Evidencia y sea aplicable a organizaciones odontológicas venezolanas, surgió de la necesidad de proporcionar una herramienta efectiva a las personas que ocupan posiciones gerenciales en tales instituciones y, por extensión, en organizaciones de salud en general. En tal sentido, dicho modelo podría contribuir, por un lado, a reducir los niveles de incertidumbre en el gerente al contar con la posibilidad de definir cursos de acción orientados a la resolución de problemas sobre una base objetiva, y por otro, a incrementar la eficiencia y eficacia del proceso administrativo que sirve de soporte a las actividades asistenciales, mejorando así su calidad y, en consecuencia, la cobertura de las instituciones al minimizarse los desperdicios que suelen ocasionar decisiones inadecuadas. Asimismo, la generación de nuevos constructos teóricos asociados a la toma de decisiones constituye un valioso aporte al campo de la gestión de los servicios y sistemas de salud. Para el logro del objetivo planteado, se llevó a cabo un estudio de desarrollo teórico en el que se realizó un análisis crítico y sistemático de las teorías y modelos existentes, incorporándose a la propuesta aquellos elementos que se ajustaron de mejor manera a sus requerimientos. Estos a su vez se integraron a los métodos de búsqueda, análisis y uso de información propios de la Práctica Clínica Basada en Evidencia. El resultado fue la definición de un nuevo modelo de toma de decisiones gerenciales, centrado en el uso de información válida, que se denominó "Modelo de Toma de Decisiones Gerenciales en Salud Basada en Evidencia"

Current attention to increasing access to family planning has increased focus on ensuring that policy, programming and practice are “evidence-based.” Given the rich history of research in the family planning field, this paper set out to answer when, what types and how evidence is used in decision-making related to family planning. Views of what constitutes evidence need to be more aligned, with researchers understanding that “evidence-based” does not only mean “research evidence-based” to decision-makers and with decisionmakers understanding the value of robust research evidence among other evidence they consider when making decisions. Decision-makers appreciate research but it is only one factor they take into consideration - and may not be the most influential factor in their decision-making. Research findings tend to be filtered through decision-makers’ values and beliefs in addition to political, economic and social considerations. Examples from family planning reinforce the persistence of other factors affecting decision-making. A number of promising interventions exist to increase how research evidence, vis a vis other factors, can inform decision-making. Expecting policy or program change from single studies is mostly unrealistic, but examples from decades of family planning programming shown in this paper illustrate the incremental influence of evidence from research on family planning policies and programs.

Dr Philip Pettit is a Senior Officer (Educational Performance and Reporting) at the Catholic Education Office, Archdiocese of Canberra and Goulburn, Manuka, ACT, Australia. His doctoral studies centred on the role of educational leadership at the school and system level. Titled 'From data-informed to data led? School leadership within the context of external testing', the research centred on how the use of student performance data is led in schools, and the implications for system-wide planning, teaching and learning, accountability and educational leadership. His professional and research activities include a keen interest in moral agency and moral potency as the basis for decision-making to promote school improvement and improved learning outcomes for students.

In this dissertation the author presents a small scale study on the move towards a more evidence-based decision making approach in the management of academic departments and programmes at Dubai Women’s College (DWC), part of the United Arab Emirates (UAE) Higher Colleges of Technology (HCT) system. Focussing on a small group of ‘middle leaders’, the study seeks to analyse how the process of establishing an evidence based culture in an educational institution unfolds and what educational leaders can learn from this process. Using a review of pertinent literature, a small survey, interviews and an analysis of relevant institutional documents, the dissertation examines the nature and scope of evidence-based approaches for decision making; investigates this in the DWC context; identifies what the target group believe constitutes evidence; describes how they work with evidence; and examines key variables such as organizational culture, the role of IT and management information systems and the influence of various paradigms and models like school effectiveness, school improvement, quality management, and learning communities in the whole process of moving to more evidence based (EB) approaches.

Government to Government (G2G) partnerships between countries in the BRICS partnerships have
significantly increased and with it, the need for more effective evidence-based decision-making. In this process,
improved M&E and KM has become prominent. In this context, the study investigated the need for Monitoring &
Evaluation (M&E), as well as knowledge management (KM) systems in partnerships. This study focused on the
development management aspects of such partnerships and the article is based on research information obtained
through the PhD study by Dr Ivy Chen as well as updated research perspectives.
The article concluded that a need existed to establish more advanced M&E and KM systems in G2G partnerships. The
Readiness Assessment conducted regarding M&E showed that a need existed for Results-Based M&E that can be used
to ensure evidence-based decision-making in the G2G partnerships. The Readiness Assessment showed that a definite
need existed for Communities of Practice (COPs) beyond the formal meetings and that professionals and practitioners
on both sides needed to exchange explicit and implicit knowledge. A need also existed for improved ICTs basedsystems including dedicated portals where policy documentation, programme information and data, as well as M&E
results, can be loaded and shared by Governments.

We conducted a pilot study to assess microbiological safety of chicken litter, an affordable organic and main fertilizer used in Cameroon and worldwide. A convenience sampling of 26 farms was done and a questionnaire was administered. Samples of litter were aseptically collected. E. coli and Salmonella spp. were isolated using CLSI standards. Antibiotic susceptibility testing was performed using the disc diffusion method and a micro broth dilution method for colistin. In broiler farms, 90% of participating farmers gave antibiotic prophylaxis. The prevalence of E. coli and Salmonella spp. was 59.1% and 15.5%, respectively. All E. coli isolates were multidrug resistant as well as 36.4% for Salmonella spp. No resistance was found against cefepime and imipenem. All Salmonella spp. tested were found sensitive to colistin while 26.7% of E. coli spp. were colistin resistant. Contamination of chicken litter may be an underestimated source of antimicrobial resistance (AMR) transmission towar...

A B S T R A C T There are high expectations for contemporary forestry research, and sustainability research more broadly, to have impact in the form of improved institutions, policy and practice and improved social and environmental conditions. As part of this trend, there has been an evolution of research approaches that move beyond isolated, reductionist, disciplinary science toward approaches that integrate disciplines (interdisciplinary) and that engage a wider range of research stakeholders (trans-disciplinary) as a way to be more effective. While these approaches evolve, there are good opportunities to learn from the experience of projects that have had impact at some level. This paper presents lessons from a case-study of a research project that succeeded in crossing the science-policy interface. Our study characterizes the design and implementation of a research project on the influence of timber harvesting on Brazil nut production using transdisciplinary research (TDR) design principles, and empirically assesses project outputs and outcomes in relation to a project theory of change (ToC) based on document review and key informant interviews. The Brazil Nut Project included some TDR elements and realized a substantial part of its ToC. The interviews identified mixed perceptions of the research design, implementation and the extent of outcomes achievement from different stakeholder perspectives. Our analysis suggests that limited stakeholder engagement was a crucial factor affecting perceptions of legitimacy and relevance, the two main TDR principles underpinning the overall research effectiveness in our study. The application of the TDR analytical framework indicates substantial scope to improve research effectiveness, even without striving for a TDR theoretical ideal.

We conducted a pilot study to assess microbiological safety of chicken litter, an affordable organic and main fertilizer used in Cameroon and worldwide. A convenience sampling of 26 farms was done and a questionnaire was administered. Samples of litter were aseptically collected. E. coli and Salmonella spp. were isolated using CLSI standards. Antibiotic susceptibility testing was performed using the disc diffusion method and a micro broth dilution method for colistin. In broiler farms, 90% of participating farmers gave antibiotic prophylaxis. The prevalence of E. coli and Salmonella spp. was 59.1% and 15.5%, respectively. All E. coli isolates were multidrug resistant as well as 36.4% for Salmonella spp. No resistance was found against cefepime and imipenem. All Salmonella spp. tested were found sensitive to colistin while 26.7% of E. coli spp. were colistin resistant. Contamination of chicken litter may be an underestimated source of antimicrobial resistance (AMR) transmission towards animals, humans and the environment with multidrug resistant E. coli and Salmonella spp. This shows the need and opportunity for a One Health approach in AMR surveillance and control in Cameroon. Continued surveillance in chicken litter would enable monitoring of AMR risks and trends

This study examines the sources of evidence that influence decision-makers who design or develop office buildings, and aims to explain why some managers engage more in evidence-based practice (EBP) than others. A mixed methods approach is conducted that combines quantitative results from 187 senior managers in the built environment and qualitative data from 18 interviewees. The respondents evaluated the use and trustworthiness of different sources of evidence, followed by an assessment of practitioners’ adoption and understanding of EBP. This study discovers notable differences between how practitioners and academics view EBP. The results highlight the importance of a manager’s
learning goal orientation, the cultural norms of the work environment, and the industry-wide barriers for EBP. Implications for the adoption of EBP in the built environment at the individual, organisational, and industry levels are put forward.

The conservation of biodiversity is an increasingly challenging endeavour. Current pressures from a growing human population have led to concerns of a sixth mass extinction event, bringing mounting pressure to find effective ways of conserving biodiversity (Barnosky et al., 2011). However, our ability to meet this challenge is affected by the fact that not everyone supports conservation objectives. People naturally have different interests and priorities, some of which may be diametrically opposed to conservation objectives. In some cases, these differences lead to damaging and costly conflicts that we see emerging across the world and which present major challenges to modern conservation (MacDonald and Service, 2007).

Policy research has convincingly demonstrated the significance of the role of policy entrepreneurs, who bring in new ideas for how to define and solve policy problems, in policymaking processes (e.g., Verger, 2012). One of the resources that policy entrepreneurs draw upon is empirical research. However, entrepreneurs often advocate for certain ideologies and perspectives, using research in a strategic way to promote a particular solution. The identity and ideology of the knowledge entrepreneur also matter, including whether they are involved in a particular political party, a certain think tank, or a non-governmental organization or whether they work as a researcher at a university. According to , research-based evidence is likely to be used in combination with other evidence in line with the elected officials' core values that evoke their positive response. For example, Kingdon (1995) noted

Objective – The primary objective was to examine online journal database usage statistics for a provincial ministry of health in the context of evidence based decision-making. In addition, the study highlights implementation of the Journal Access Centre (JAC) that is housed and powered by the Ontario Ministry of Health and Long-Term Care (MOHLTC) to inform health systems policy-making. Methods – This was a prospective case study using descriptive analysis of the JAC usage statistics of journal articles from January 2009 to September 2013. Results – JAC enables ministry employees to access approximately 12,000 journals with full-text articles. JAC usage statistics for the 2011-2012 calendar years demonstrate a steady level of activity in terms of searches, with monthly averages of 5,129. In 2009-2013, a total of 4,759 journal titles were accessed including 1,675 journals with full-text. Usage statistics demonstrate that the actual consumption was over 12,790 full-text downloaded arti...

We conducted a pilot study to assess microbiological safety of chicken litter, an affordable organic and main fertilizer used in Cameroon and worldwide. A convenience sampling of 26 farms was done and a questionnaire was administered. Samples of litter were aseptically collected. E. coli and Salmonella spp. were isolated using CLSI standards. Antibiotic susceptibility testing was performed using the disc diffusion method and a micro broth dilution method for colistin. In broiler farms, 90% of participating farmers gave antibiotic prophylaxis. The prevalence of E. coli and Salmonella spp. was 59.1% and 15.5%, respectively. All E. coli isolates were multidrug resistant as well as 36.4% for Salmonella spp. No resistance was found against cefepime and imipenem. All Salmonella spp. tested were found sensitive to colistin while 26.7% of E. coli spp. were colistin resistant. Contamination of chicken litter may be an underestimated source of antimicrobial resistance (AMR) transmission towar...

Many performance indicators in Australian higher education are based on the quantitative data from student feedback surveys, while the qualitative data usually generated by these surveys receive relatively limited attention. This paper argues that these data, if collected and analysed in a systematic way, can be used as an effective and robust institutional performance indicator and can assist the process of quality improvement. The paper describes a comparative analysis of qualitative data generated at a large metropolitan multi-campus university by three key student surveys in 2006. These surveys track students’ and graduates’ exp erience of their individual subjects, their course and overall experience of their University. In total, about 108,000 student open-ended comments have been analysed and compared with the 280,000 comments from 14 other universities. The results, obtained via CEQuery–a software tool that facilitates analysis of the written comments, were benchmarked and i...

Teachers make hundreds of critical decisions each school day. Educators decide which curriculum to adopt, how to support struggling learners, what to do about students with behavioral challenges, how to teach, and how and when to adjust lessons. The most effective choices are those made using the best available evidence. In recent years, the evidence-based practice movement has raised questions about what makes up a practical, evidence-based approach. The summer 2021 newsletter examines research that support best practices in effective decision-making. How to Make Informed Decisions Wing Institute Original Work This newsletter contains five Wing Institute papers on decision-making. We want to thank Kendra Guinness for her contributions to this month's newsletter. Kendra provides the recently published paper titled, Best Available Evidence.

Evidence based management improves organizational decisions as a bridge from theory to practice. Using best available literature and measures to obtain health organizational decisions are of vital important,This study aimed at determining the level of manager's awareness of evidence based decision making in Tehran public hospitals. The cross-sectional study was conducted in 2013, in which purposive sampling of public educational hospital managers of Tehran medical university was done. The data collection tool was a structured questionnaire in 8 sections with ascertained validity and determined reliability of chronbach alpha %78. All data were computed and analyzed by SPSS version18 Software. T test.Chi-square and ANOVA values were calculated to analyze the data. The 70th participants consisted of all the senior and junior managers of public-training hospitals in Tehran University of Medical Sciences, including hospital manager, finance director, director of administration, hospital matron. The managers' awareness of evidence-based management in the hospitals was reported to be equal and was not significantly different. Furthermore, there was no significant correlation between managers' education level and their awareness of evidence-based management and among managers' awareness, marital status, and age. The limited awareness of hospital managers regarding the concept and content of evidence-based management is a major challenge for sophisticated and efficient management in health organizations.

Letter in response to Gibbins KJ, Weber T, Holmgren CM, et al. Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus. Am J Obstet Gynecol. 2016 Jan 20. I read with interest about the 20 women with uterine rupture none of whom had previous cesareans, but all of whom had either pitocin induction or augmentation or both. (1) The authors dismissed Pitocin as a cause of the uterine rupture because: "Although women with primary rupture were more likely to undergo labor induction and/or oxytocin augmentation during labor, these latter differences likely reflect differences in provider management among women with a scarred uterus." This is the common mistake called 'the error of small numbers' (2) for which, among other things, Kahneman won the Nobel prize. Behavioral economics teaches us that uterine rupture among women without a previous Cesarean is a rare finding for which significant findings cannot be drawn by comparing their rates of labor induction and augmentation to induction and/or augmentation rates for women with previous cesarean scars. The significant finding is that not a single woman with an unscarred uterus experienced uterine rupture in the absence of labor induction and/or augmentation. The same exact finding was repeated in another recent study on the same subject. (3) The unscarred uterus that is not artificially forced to contract, will not contract so hard as to explode itself, as Williams Obstetrics taught for generations. Not a single case of a uterine rupture on a previous unmanipulated uterus (including D&C, shirodkar, etc) has ever been documented in the absence of induction or augmentation. It is important and even potentially life saving to underline the fact that a woman with an unscarred uterus can be 100% sure of avoiding uterine rupture if they avoid medical induction and augmentation. 1 Gibbins KJ, Weber T, Holmgren CM, et al. Maternal and fetal morbidity associated with uterine rupture of the unscarred uterus. Am J Obstet Gynecol 2015;213:382.e1-6.

In this article we call for a new approach to patient safety improvement, one based on the emerging field of evidence-based healthcare risk management (EBHRM). We explore EBHRM in the broader context of the evidence-based healthcare movement, assess the benefits and challenges that might arise in adopting an evidence-based approach, and make recommendations for meeting those challenges and realizing the benefits of a more scientific approach.