Force field analysis of driving and restraining factors affecting the evidence-based decision-making in health systems; comparing two approaches

Tahereh Shafaghat; Mohammad Kazem Rahimi Zarchi; Mohammad Hasan Imani Nasab; Zahra Kavosi; Mahammad Amin Bahrami; Peivand Bastani

doi:10.4103/jehp.jehp_1142_20

Force field analysis of driving and restraining factors affecting the evidence-based decision-making in health systems; comparing two approaches

J Educ Health Promot. 2021 Nov 30:10:419. doi: 10.4103/jehp.jehp_1142_20. eCollection 2021.

Authors

Tahereh Shafaghat¹, Mohammad Kazem Rahimi Zarchi², Mohammad Hasan Imani Nasab³, Zahra Kavosi⁴, Mahammad Amin Bahrami⁴, Peivand Bastani⁴

Affiliations

¹ Student Research Committee, Department of Health Care Management, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
² Department of Health Care Management, Health Policy and Management Research Center, School of Public Health, Shahid Saoughi University of Medical Sciences, Yazd, Iran.
³ Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
⁴ Health Human Recourses Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.

Abstract

Background: All policies and decisions need evidence examined by scientific methods. Moving toward evidence-based decision-making (EBDM) as a change in organizations, especially health systems (HSs), is inevitable. This study was conducted to identify the factors affecting EBDM in HSs from two approaches and to score them.

Materials and methods: A mixed-method study was carried out using the force field analysis regarding the change toward EBDM in HS in 2020. This study included six steps to identify and score the key driving forces (DFs) and restraining forces (RFs) to change toward the EBDM in HS: first, finding forces from literature; second, selecting key DFs and RFs through focus group discussion; third, scoring the first group of DFs and RFs by the experts through electronic forms; fourth, determining key DFs and RFs from the managers' perspective using qualitative interviews; fifth, scoring the second group of DFs and RFs by the experts; and sixth, comparison between forces resulted from two approaches.

Results: According to the literature and experts' opinions, "relevant, reliable, interpretable, and understandable evidence" and "interaction between researchers and decision-makers" were the strongest forces to change, and "lack of organizational commitment and support" and "lack of relevant/high-quality evidence" were the strongest forces against the change toward EBDM in HS. Further, based on managers' perspective and scores by the experts, "suitable supervision and control" and "reforming the planning and decision-making system" were the strongest forces to change, and "inadequate knowledge of the managers and staff about the principles and contents of EBDM" and "issues beyond the authorities of managers" were the strongest forces against the change toward EBDM in HS.

Conclusions: Based on the findings, HSs' managers can focus to reduce RFs and promote DFs for implementing EBDM strategies, so they can provide better services by making more efficient decisions.

Keywords: Evidence-based healthcare; force field analysis; health system agencies; organizational changes; policy-making.