Mozzilla COO John Lilly wrote a comment in response to my post on "evidence-based everything," which is quite insightful as he points out the "instrumentation" and responding to the numbers has become a core part of running an Internet business. He mentions YouTube and Google as examples, and I know that gathering and responding to hard evidence — and doing it as a way of life — also happens at eBay and Yahoo! In addition, I was at a Stanford d.school gathering last year where John argued that, because evidence about customer behavior is so easy to gather on the web, the way that an Internet start-up is pitched to venture capitalists has changed dramatically since boom in the late 1990’s.  Check out this attached article that Pfeffer and I wrote called Why Managing By Facts Works. It starts out with a great example from John about why having just a great PowerPoint based talk isn’t enough these days — you have to show that people actually want what you’ve got.

I announced a few weeks in a post that, with some great help from Daphne Chang and Paul Reist at the Stanford Business School Library, and from Management Science & Engineering PhD student Ralph Maurer, Jeff Pfeffer and I had launched www.evidence-basedmanagement.com. We have continued to work on the site, and the greatest improvement has been the work that Daphne and Paul have done in identifying an astounding range of evidence-based movements, and providing links to key information. Check out their list of other evidence-based movements, which include evidence-based conservation, evidence-based crime prevention, evidence-based government (imagine that!), evidence-based medicine (the most completely developed), evidence-based social work, and evidence-based software engineering.

Certainly, the meaning of an evidence-based approach means different things in different places. But the common theme I see across all these movements — and why the term evidence-based is so value and is spreading — is that people across all these areas want the best decisions made and implemented because money and lives are at stake, and rather than taking steps that are based on what has always been done, what sustains the power structure, or provides the largest financial payoff to the most persuasive salespeople, I believe these movements represent a desire and commitment to do the right thing.  Sure, ideology and greed will always bias the decisions that people make and implement, but pressing people to face and follow the best facts is a new, noble, and sometimes effective hurdle.  Indeed, there are signs people with best evidence do and can win — and to see how it is done, if you haven’t already, check out Al Gore’s brilliant and simple arguments about global warming in An Inconvenient Truth.

I’ve written before about how handwashing by medical care workers is one of the most well-documented preventable causes of death and disease in health care settings. One hospital CEO, for example, told me that he wore a button that said "It is OK to Ask," to encourage patients to ask doctors if they had washed their hands — a practice the doctors didn’t like, but that did have positive effects.  Last Sunday’s New York Time Magazine had a splendid article by Dubner and Levitt called "Selling Soap."    The story contains many lessons that go far beyond hand-washing and have implications for evidence-based management on many other things. Consider four:

1. Self-report data can be worse than useless. They describe an Australian study where 73% of doctors reported washing their hands, but when the docs were observed by a researcher only 9% were seen washing their hands. The lesson is that you need to check out what people say, interviewing the people you are trying to help and change produces very suspect data.

2. The story focuses on Cedars-Sinai Medical Center and efforts to get physicians to wash their hands. Nagging doctors with emails and posters didn’t work. But the Hand Hygiene Safety Posse did — they roamed the halls and when they saw a doctor washing his or her hands, they handed out a small reward on the spot, a $10 Starbucks gift certificate. This had substantial effects, getting compliance up to 80% from 65% — but they were aiming to hit 90% for a pending inspection.

3. The way they finally got compliance up to nearly 100% was to have a group of the hospitals more influential  doctors each press their palms on plates that were cultured and photographed, which resulted in images that "were disgusting and and striking, with gobs of colonies of bacteria." One of these was used as a screen saver that was placed on every computer in the hospital. The power of this last intervention not only provides lessons about hospitals, it is a lesson about how to implement any other change that people "know" is good, but aren’t doing:

A. They started by changing some of the most powerful and persuasive people in the system — opinion leaders and people with high status are important for sparking change.

B. They spread the information to everyone in the system, so they could all keep an eye on each other.  This made the norm open and easy to monitor — and vivid.

C. They made the dry statistical information very vivid. The disgusting picture is the perfect kind of image that sticks in people’s minds — check out Heath and Heath’s Made to Stick. This is one of their kep principles.

D. Finally, they created the kind of social pressure where if people did not follow the norm, it would lead to loss of face. Economists and psychologists like financial rewards, and as this tale shows, incentives are effective to a point. But if you can find ways that people feel compelled to follow the evidence, or they will suffer humilation in the eyes of the people around them, that is even more effective. It is a lot easier to measure and dispense financial rewards, but if you want to change human behavior, it is hard to beat pride and shame — as sociologists including Erving Goffman   have demonstrated.

Finally, this story, to me, is another sign that focusing on managing the system is more important than devoting excessive energy to bringing in star talent — that the law of crappy systems trumps the law of crappy people.  This hospital clearly has many smart and well-meaning people. But the compliance rate was only about 65% until management started changing the system, first through rewards (which got them up to 80%), and then through those disgusting pictures (which pushed them to close to %100). These are all the same people, they were just managed differently.