Journal of Education and Health Promotion

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

Document Type : Original Article

Authors

. Tahereh Shafaghat 1
. Mohammad Kazem Rahimi Zarchi 2
. Mohammad Hasan Imani Nasab 3
. Zahra Kavosi 4
. Mahammad Amin Bahrami 4
. Peivand Bastani 4

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
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Journal of Education and Health Promotion
Volume 11, Issue 10
November 2021
Pages 1-10

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