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- ISBN: 9780199205103 | 0199205108
- Cover: Paperback
- Copyright: 8/24/2006
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.
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.
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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