Knowledge to action? : evidence-based health care in context / edited by Sue Dopson and Louise Fitzgerald.

Format:

Book

Contributor:

Dopson, Sue.

Fitzgerald, Louise, 1945-

Language:

English

Subjects (All):

Evidence-based medicine--Great Britain.

Evidence-based medicine.

Evidence-Based Medicine.

United Kingdom.

Great Britain.

Medical Subjects:

Evidence-Based Medicine.

United Kingdom.

Physical Description:

xi, 223 pages ; 25 cm

Place of Publication:

New York : Oxford University Press, 2005.

Summary:

Health services can and should be improved by applying research findings about best practice. Yet, in Knowledge to Action?, the authors explore why it nevertheless proves notoriously difficult to implement change based on research evidence in the face of strong professional views and complex organizational structures.

The book draws on a large body of evidence acquired in the course of nearly fifty in-depth case studies, following attempts to introduce evidence-based practice in the UK NHS over more than a decade. Using qualitative methods to study hospital and primary care settings, they are able to shed light on why some of these attempts succeeded where others faltered. By opening up the intricacies and complexities of change in the NHS, they reveal the limitations of the simplistic approaches to implementing research or introducing evidence-based health care.

A unique synthesis of evidence, the book brings together data from 1,400 interviews with doctors, nurses, and managers, as well as detailed observations and documentary analysis. The authors provide an analysis, rooted in a range of theoretical perspectives, that underlines the intimate links between organizational structures and cultures and the utilization of knowledge, and draws conclusions which will be of significance for other areas of public management. Their findings have implications for the utilization of knowledge in situations where there is a professional tradition working within a politically sensitive blend of public service, managerial accountability, and technical expertise. Knowledge to Action? will be of interest to Academics, Researchers, and Advanced Students of Organizational Behaviour, Public and Health Management, and Evidence-Based Medicine; and also of particular interest to Practitioners, Clinicians, and Public Health Managers concerned with implementing change to clinical practice.

Contents:

2 Studying Complex Organizations in Health Care / Ewan Ferlie, Sue Dopson 8

2.2 Key research traditions within organizational studies 11

2.3 Qualitative organizational research 12

2.4 Three core models of organization 13

2.4.1 Modernist perspective 13

2.4.2 Symbolic interpretive perspective, enactment, and the social construction of reality 14

2.4.3 Postmodern organizational theory 15

2.5 Organizational studies and the analysis of health care organizations: differing development patterns 16

2.6 The current literature on EBHC implementation and an organizational 'gap' 17

2.7 High organizational complexity and variability: implications for EBHC implementation 21

2.7.1 The importance of context 21

2.7.2 Processes, not events 23

2.7.3 The contestability of evidence 23

2.7.4 Multiple actors 24

2.7.5 Autonomous professional groupings 24

2.7.6 Cognitive boundaries: different research paradigms 25

2.8 Methodological implications: a finely grained approach to analysing EBHC initiatives 26

3 Evidence-Based Health Care and the Implementation Gap / Sue Dopson, Louise Locock, John Gabbay, Ewan Ferlie, Louise Fitzgerald 28

3.2 What is EBHC? 29

3.3 The rationale for EBHC: the gap between research and practice 31

3.4 The emergence of the EBHC movement 32

3.4.1 Interest from policy-makers 34

3.5 Can EBHC bridge the implementation gap? 36

3.6 From EBHC to EBP? 46

4 Research Design: 'Upscaling' Qualitative Research / Louise Locock, Ewan Ferlie, Sue Dopson, Louise Fitzgerald 48

4.2 The positivistic paradigm and HSR 49

4.3 The interpretive paradigm and HSR 51

4.4 What are the signs of rigour within qualitative research? 53

4.5 Case study design 54

4.5.1 Improving the quality of case study research 54

4.6 Upscaling: a search for higher external validity 57

4.7 Our methods 64

4.7.1 Cross-study comparison: are our seven studies similar or different? 65

4.8 Methodological challenges in cross-study synthesis 73

4.8.1 The complexity of process data 73

4.8.2 Synthesizing data on multiple units and levels of analysis with ambiguous boundaries 74

4.8.3 The influence of the theoretical assumptions of researchers and issues of interpretation 74

5 The Active Role of Context / Sue Dopson, Louise Fitzgerald 79

5.2 Context and organizational studies 80

5.3 Aspects of context that influence the career of EBHC initiatives 87

5.4 What are the building blocks of a more sophisticated notion of context? 98

6 Professional Boundaries and the Diffusion of Innovation / Louise Fitzgerald, Sue Dopson 104

6.2 Power, professional jurisdiction, and the State 106

6.3 The role of knowledge in securing and maintaining professional status 108

6.4 Becoming a professional: professional socialization and training 109

6.5 Professionals as managers and managers as professionals 113

6.5.1 Professionals as managers 114

6.6 Review of our empirical material on professional boundaries and their impact on translation processes 116

6.6.1 The role of the State in the diffusion of innovations 117

6.6.2 Professional socialization and the diffusion of innovations across social boundaries 117

6.6.3 Cognitive professional boundaries and hierarchies of credible evidence 121

6.6.4 Mechanisms for moving across boundaries 123

6.6.5 The role of professionals as managers 125

6.7.1 On the power of the professions and power dynamics within the diffusion process 125

6.7.2 On the changing social relationships of professional work 128

6.7.3 On the complexity of professional boundaries and influence processes 128

7 Knowledge, Credible Evidence, and Utilization / Louise Fitzgerald, Sue Dopson 132

7.2 From knowledge creation to diffusion and management 134

7.3 Review of empirical data on the credibility of evidence 138

7.3.1 A hierarchy of evidence? Perceptions of credible evidence 138

7.3.2 Processes of accepting research evidence: appraisal or trust 145

7.3.3 The role of tacit or experiential knowledge 149

7.3.4 Other sources of evidence 150

8 Knowledge in Action / Louise Fitzgerald, Sue Dopson, Ewan Ferlie, Louise Locock 155

8.2 Illustrative vignettes 157

8.2.1 Aspirin to prevent secondary cardiac incidents 157

8.2.2 Services for heart failure 159

8.2.3 Managing anticoagulation provision in primary care with a computer support system 163

8.2.4 Diabetes care 165

8.2.5 Maternity care 169

8.2.6 Glue ear 171

8.3.1 Multiple cues affecting the processes of innovation utilization 175

8.3.2 Multifaceted contexts with differential power to influence 176

8.3.3 Evidence is important, and is translated into use through social processes 178

8.3.4 Configuration of variables 179

8.3.5 Complementary collective and individual processes 179

9 Conclusion: From Evidence to Actionable Knowledge? / Ewan Ferlie 182

9.1 Developing a social perspective on the enactment of evidence 182

9.1.1 Key elements of the social perspective 184

9.1.2 The professionalized organization, health care professions, and their boundaries 186

9.1.3 A knowledge management perspective? 188

9.2 Some policy implications 191

9.2.1 Clinical opinion leaders and clinical leadership 191

9.2.2 Moving knowledge across boundaries 192

9.2.3 EBHC policy in the future 193

9.3 Future research needs 194

9.3.1 Knowledge types and their combination 194

9.3.2 Learning from the positive outliers 195

9.3.3 Some methodological issues 195

9.3.4 Final thoughts: a social perspective on the enactment of EBHC 196.

Notes:

Includes bibliographical references (pages [198]-212) and index.

ISBN:

0199259011

OCLC:

57494023