Knowledge to Action? Evidence-Based Health Care in Context

by Dopson, Sue; Fitzgerald, Louise

• ISBN13: 9780199205103
• ISBN10: 0199205108
• Format: Paperback
• Copyright: 2006-08-24
• Publisher: Oxford University Press

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.

Author Biography

Sue Dopson is a Fellow in Organization Behaviour and Vice-President at Templeton College, the University of Oxford. A member of the Oxford Health Care Management Institute, she is involved in the development of courses for the NHS and a number of research projects, including the evaluation of projects aimed at improving clinical effectiveness, exploring issues of getting the results of medical research evidence into clinical practice, and more general research in the area of NHS management. She has published several books and articles on the changes in the management of the NHS, the changing nature of middle management, management careers, and developments in public sector management. Louise Fitzgerald is Professor of Organizational Development in the Department of Human Resource Management at De Montfort University. She completed her PbD whilst a lecturer at Salford University, was a Senior Lecturer at Warwick University, and a Professor and Director of Research at St. Bartholomew's School of Nursing and Midwifery, City University. Her research interests centre on the management of change in professional organizations, particularly health care, and she has published widely in journals such as Human Relations, Personnel Review, and the Journal of Health Services Research and Policy, as well as having co-authored several books including The New Public Management in Action (OUP, 1996). Ewan Ferlie is Professor of Public Services Management, and Head of Department, at the School of Management, Royal Holloway, University of London. He has published widely on questions of organisational change and restructuring in the public services, especially health care. He has published in such journals as Organisational Studies, Human Relations, the Milbank Quarterly and the British Journal of Management (of which he has been Associate Editor). He has been a Non Executive Member of Warwickshire Health Authority.
John Gabbay is Professor of Public Health and Director of the Wessex Institute for Health R&D, University of Southampton. He has previously taught at the Department of History and Philosophy of Science, University of Cambridge, trained in public health in the Oxford Region, gained an MSc in Community Medicine at the London School of Hygiene and Tropical Medicine, and conducted research at Templeton College, Oxford. His recent research has examined the use of medical knowledge in the delivery of health services, including a study of communities of practice in the design of care for the elderly, an ethnographic study of knowledge management in primary care, a qualitative study of GP and patient views on depression, and an evaluation of the development of Diagnosis and Treatment Centres.

Table of Contents

List of Tables	p. xiii
List of Figures	p. xiii
List of Appendices	p. xiii
Abbreviations	p. xv
Introduction	p. 1
The organization of the book	p. 2
Studying Complex Organizations in Health Care	p. 8
Introduction	p. 8
Key research traditions within organizational studies	p. 11
Qualitative organizational research	p. 12
Three core models of organization	p. 13
Modernist perspective	p. 13
Symbolic interpretive perspective, enactment, and the social construction of reality	p. 14
Postmodern organizational theory	p. 15
Organizational studies and the analysis of health care organizations: differing development patterns	p. 16
The current literature on EBHC implementation and an organizational 'gap'	p. 17
High organizational complexity and variability: implications for EBHC implementation	p. 21
The importance of context	p. 21
Processes, not events	p. 23
The contestability of evidence	p. 23
Multiple actors	p. 24
Autonomous professional groupings	p. 24
Cognitive boundaries: different research paradigms	p. 25
Methodological implications: a finely grained approach to analysing EBHC initiatives	p. 26
Concluding remarks	p. 26
Evidence-Based Health Care and the Implementation Gap	p. 28
Introduction	p. 28
What is EBHC?	p. 29
The rationale for EBHC: the gap between research and practice	p. 31
The emergence of the EBHC movement	p. 32
Interest from policy-makers	p. 34
Can EBHC bridge the implementation gap?	p. 36
From EBHC to EBP?	p. 46
Concluding remarks	p. 46
Research Design: 'Upscaling' Qualitative Research	p. 48
Introduction	p. 48
The positivistic paradigm and HSR	p. 49
The interpretive paradigm and HSR	p. 51
What are the signs of rigour within qualitative research?	p. 53
Case study design	p. 54
Improving the quality of case study research	p. 54
Upscaling: a search for higher external validity	p. 57
Our methods	p. 64
Cross-study comparison: are our seven studies similar or different?	p. 65
Methodological challenges in cross-study synthesis	p. 73
The complexity of process data	p. 73
Synthesizing data on multiple units and levels of analysis with ambiguous boundaries	p. 74
The influence of the theoretical assumptions of researchers and issues of interpretation	p. 74
Concluding remarks	p. 76
The Active Role of Context	p. 79
Introduction	p. 79
Context and organizational studies	p. 80
Aspects of context that influence the career of EBHC initiatives	p. 87
What are the building blocks of a more sophisticated notion of context?	p. 98
Concluding remarks	p. 102
Professional Boundaries and the Diffusion of Innovation	p. 104
Introduction	p. 104
Power, professional jurisdiction, and the State	p. 106
The role of knowledge in securing and maintaining professional status	p. 108
Becoming a professional: professional socialization and training	p. 109
Professionals as managers and managers as professionals	p. 113
Professionals as managers	p. 114
Review of our empirical material on professional boundaries and their impact on translation processes	p. 116
The role of the State in the diffusion of innovations	p. 117
Professional socialization and the diffusion of innovations across social boundaries	p. 117
Cognitive professional boundaries and hierarchies of credible evidence	p. 121
Mechanisms for moving across boundaries	p. 123
The role of professionals as managers	p. 125
Concluding remarks	p. 125
On the power of the professions and power dynamics within the diffusion process	p. 125
On the changing social relationships of professional work	p. 128
On the complexity of professional boundaries and influence processes	p. 128
Knowledge, Credible Evidence, and Utilization	p. 132
Introduction	p. 132
From knowledge creation to diffusion and management	p. 134
Review of empirical data on the credibility of evidence	p. 138
A hierarchy of evidence? Perceptions of credible evidence	p. 138
Processes of accepting research evidence: appraisal or trust	p. 145
The role of tacit or experiential knowledge	p. 149
Other sources of evidence	p. 150
Concluding remarks	p. 152
Knowledge in Action	p. 155
Introduction	p. 155
Illustrative vignettes	p. 157
Aspirin to prevent secondary cardiac incidents	p. 157
Services for heart failure	p. 159
Managing anticoagulation provision in primary care with a computer support system	p. 163
Diabetes care	p. 165
Maternity care	p. 169
Glue ear	p. 171
Concluding remarks	p. 175
Multiple cues affecting the processes of innovation utilization	p. 175
Multifaceted contexts with differential power to influence	p. 176
Evidence is important, and is translated into use through social processes	p. 178
Configuration of variables	p. 179
Complementary collective and individual processes	p. 179
Conclusion: From Evidence to Actionable Knowledge?	p. 182
Developing a social perspective on the enactment of evidence	p. 182
Key elements of the social perspective	p. 184
The professionalized organization, health care professions, and their boundaries	p. 186
A knowledge management perspective?	p. 188
Some policy implications	p. 191
Clinical opinion leaders and clinical leadership	p. 191
Moving knowledge across boundaries	p. 192
EBHC policy in the future	p. 193
Future research needs	p. 194
Knowledge types and their combination	p. 194
Learning from the positive outliers	p. 195
Some methodological issues	p. 195
Final thoughts: a social perspective on the enactment of EBHC	p. 196
References	p. 198
Index	p. 213
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