1. Issel, L. Michele PhD, RN

Article Content

For the first time in the 34-year history of Health Care Management Review, this issue begins with a peer-reviewed manuscript, followed by three corresponding invited commentaries written by widely recognized scholars in health administration, and concluding the authors' response to the commentaries. The decision to introduce this format stemmed directly from the reactions of the peer reviewers to the original submission. The reactions were an usual mix of support and skepticism, which made me realize that something interesting was embodied in the topic of the paper. To bring the ambivalence and the science into greater relief, I choose the invited commentary format. From time to time, thoughtful, scholarly works will strike a chord that is simultaneously melodic and dissonant. In such cases, I plan to use the invited commentaries format as a means to stimulate healthy debates, with the intent of advancing the dialogue, the research, and the practice.

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The topic of the manuscript and the corresponding invited commentaries is evidence-based managerial practice. The authors do a wonderful job of outlining the parameters of the debate based on their own points of view. As I read the manuscript and the commentaries, I could not help but notice that the outline of the debate and the considerations presented by the set of eminent authors had missed an important element. Their focus, and rightly so, is on the application of evidence in the management of the organization and the possible benefits and consequences of doing so. However, health care administration functions at the intersection of medical science used by health care practitioners and organizational science used by managers. Starting from the premise that each health care organization exists to provide a means through which the health care practitioner can deliver health care leads to thinking of evidence-based practice for both sets of practitioners. Being at the intersection of two sciences means that health care administrators need to be able to use evidence from organizational research to create an environment that fosters and supports the adoption of the current best practices based on medical and health care research, especially when the best practice is not associated with new technology.


Calls for research and research funding priorities downplay evidence-based practice as a stand-alone end point and currently emphasize the broader issues of translational research and comparative effectiveness research in health care. This trend toward application of evidence, particularly notable across the federal research funding agencies and institutes, means that more than ever, health administrators will need to create organizations that are continuously adapting to the evidence base used by the variety of health professionals practicing within the organization. Clearly, most organizations do so already, and evidence does exists on how to guide, to foster, and to support the adoption of best practices by the health care practitioners. The future research emphasis must address how to manage the adoption process, by both administrators and health care practitioners, as a permanent element of the health care organization's fabric. To that end, I see the need for many more scholarly, systematic reviews of health management and administration research that identify current best practices for adoption by practicing health administrators.


L. Michele Issel, PhD, RN