Knowledge to Action?: Evidence-Based Health Care in Context

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 research evidence in the face of strong professional views and complex organizational structures.
Drawing 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.
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.

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.