We wish to thank the three commentators for enriching our discussion of evidence-based health services management (EBHSM). Each piece extends our discussion of EBHSM in important ways. We agree with nearly all of the commentators' substantive comments and offer the following reactions as a way of pushing the discussion forward. Damore asks why EBHSM has not been used more extensively in healthcare organizations. While agreeing with the barriers to EBHSM we identified, Damore gives greater emphasis to barriers that largely lie outside an individual organization's immediate sphere of influence: (i) the lack of standardized definitions and measures of management success, (2) the paucity of accurate and valid data on the effects of management decisions adjusted for local differences in culture, values, and managers' interpersonal and leadership skills, and (3) the challenge of providing evidence-based management information to practitioners in a convenient, efficient, and accessible manner. Damore calls for renewed and improved organizational benchmarking efforts, both for the immediate value such efforts will generate for healthcare managers and for the stimulus benchmarking will provide for the field to address the three barriers he identifies. We certainly agree with Damore's comments, but we hope that healthcare managers will not wait until these difficult external challenges are overcome before undertaking internal efforts to increase the use of evidence in decision making. Even with the limited structures and resources currently available, healthcare managers could use appropriate research evidence in making decisions to a much greater extent, and organizations could begin to reward managers who do so. Our interviews revealed that managers are not rewarded nor are they punished in any significant ways for their obtaining, or failing to obtain, the most relevant data for strategic decision making that are available at reasonable cost. In fact, some improvement in this situation is already under way. We found in our interviews that managerial incentives are being realigned modestly in the right direction as a result of the influence of evidence-based medicine and nursing and the rapid deployment of pay-for-performance initiatives by external payers. However, much more could be done about external barriers, and we appreciate Damore's comment, which broadens the discussion and rightly emphasizes much-needed publicly accepted standards of organizational performance and the availability of regional and national resources to measure and usefully report performance across multiple organizations. We appreciate the connection Fine makes between EBHSM and the related field of managerial epidemiology. His suggested questions, in the ten examples, extend our discussion to health policy and public health decision making. He (in agreement with Damore) suggests that greater emphasis on organizational benchmarking will be a stimulus to EBHSM, and (in agreement with Shortell) he argues that consultants, especially those with expertise in industrial engineering and related fields, can be excellent knowledge brokers for health services managers. We appreciate the current and future potential roles consultants may play, but we also agree with Fine's warning that "the opportunity to transform the enterprise into one whose central culture is eager for data-driven managerial decision making is compromised by the Outside expert syndrome.'" Extensive use of consultants should occur in the context of an overall organizational strategy for EBHSM, not as a replacement for it. Finally, we note that Fine suggests that one of the reasons EBHSM is so little used is that many students in healthcare management training programs have significant deficiencies in quantitative analysis and related competencies. Ironically, we have little evidence to help us with this question. We suspect that the training problem lies mainly with the faculties and not the students. …