C ritics notwithstanding, evidence-based medicine (EBM) has achieved a firm hold in medical care and "evidence-based" has become part of the zeitgeist. 1 An analogous approach at the management level-evidence-based management (EBMgt)-has begun to take hold. 1,2 This movement has taken much from the EBM approach, recognizing that "Like its counterparts in mediciney, EBMgt is informed by practitioner judgment regarding experience, contextual circumstances, and ethical concernsy If a problem is generic, effective managers can benefit from understanding the principles underlying it as a guide to action. If the problem is novel, awareness of effective decision-making and problem-solving processes can aid in achieving a quality decision even under considerable uncertainty." 3 Providing evidence to improve the delivery and effectiveness of care, that is, research useful to management practice, has been a goal of health services research. 4 Unfortunately, the discipline has often fallen short. The Brief Report by Kressin et al 5 in this issue illustrates some of the issues. Viewing this paper from the perspective of a manager (former director of a primary care clinic) prompts different kinds of questions from those that focus on the concerns of a researcher.Kressin et al 5 describe clinical operations variables (organizational factors) associated with blood pressure (BP) outcomes. The pursuit of BP control has a strong supportive evidence base and there is little doubt that control of BP to achieve certain targets is associated on average with better long-term outcomes such as a lower frequency of stroke. Although individual patients do not experience outcomes on the average, the different outcome probabilities form a solid basis on which to decide whether or not to control BP. 6 Yet, from the outset, although overlooked early on, the EBM movement recognized that there was a role for judgment (clinical and ethical) in applying evidence on the average to individual patients. Nevertheless, wide variation in practice and the failures of "translating" research into practice have been a longstanding source of consternation to those interested in quality of care.The two major types of explanations offered for the failure to translate research into practice have identified the problem as a knowledge transfer gap or a knowledge production gap. 7 In the former, the failure lies primarily among the practitioners for not receiving the lessons of research and implementing them, whereas in the latter, the failure lies mostly with the researchers for producing the wrong kind of knowledge. The clinical research-practice gap has tended to focus on the first explanation, and solutions have focused on interventions targeting clinician behavior. However, criticism of the narrow entry criteria for clinical trials is an example of the second explanation. The management research-practice gap has been attributed to both practitioners (managers) and researchers. 2,7-10 The EBMgt movement began with a focus on the practitioners, citing the wide ...