The ‘best available evidence’ could be better: Evidence from systematic reviews of organizational interventions

Abstract

Evidence-informed decision-making assumes that people are more likely to make good decisions if they are informed by the best available evidence. ‘Best’ is a subjective concept. Researchers routinely make judgments about the quality of evidence and quality appraisal is part of the systematic review process. Systematic reviews of the health effects of organizational interventions have tended to find that evaluations have a high risk of bias and little to say about contexts, mechanisms and implementation. Practitioners therefore have to make decisions when the supporting evidence is poor, and when variations in outcomes may be due to differences in how the intervention has been theorised, implemented or evaluated. This chapter uses systematic review findings to illustrate this apparent methodological failing before it describes how more robust studies of organizational change can be achieved from cluster RCTs with mixed methods process evaluations.