Despite the acknowledgement that decision makers’ actions and the decision context each affect the practice of Evidence-based management (EBM), little empirical research has examined the dynamics of individual actions (agency) and the broader context (structure). Adopting a structuration theory lens, we examine the interplay between agency, and structure in the practice of EBM by hospital managers. We collect data on cases of managerial evidence-based decisions using in-depth Critical Incident Technique interviews with 36 executive managers from 11 hospitals in Lebanon. We identify 5 main factors that capture the role of agency and structure in the practice of EBM by hospital managers. Our findings underscore the deeply intertwined roles of agency and structure in shaping the practice of EBM. We demonstrate how agentic factors, such as, such as managers’ motives, within the constraints of structural factors, play a crucial role in reinforcing and mediating the extent to which managers adhere to all six-steps of the EBM process as described in the literature. As a result, we distinguish between the symbolic and instrumental practice of EBM. We conclude by reflecting on the significance of our results and exploring their theoretical and practical implications.
