Getting evidence into clinical practice: an organisational behaviour perspective

Area of Science:

• Health Services Research
• Evidence-Based Medicine Implementation
• Clinical Practice Change

Background:

• The UK National Health Service (NHS) aimed to integrate research evidence into clinical practice between 1995-1997.
• Understanding the dynamics of clinical behavior change and evidence diffusion is crucial for healthcare improvement.
• Previous efforts to reshape clinical practice faced challenges in translating research into routine care.

Purpose of the Study:

• To investigate the relationship between research evidence and clinical behavior change within the NHS.
• To examine the 'careers' of clinical change initiatives, their impact, and influencing factors.
• To analyze the role of organizational and social factors in the adoption of evidence-based practices.

Main Methods:

• Employed comparative case study methodology across four clinical change issues in one English NHS region.
• Conducted semi-structured interviews with 119 participants and performed documentary analysis.
• Utilized a two-level analysis: regional overview surveys and intensive local practice impact assessments.

Main Results:

• A weak correlation was observed between the research evidence base and its diffusion into practice.
• Evidence diffusion and uptake were socially constructed, with differential acceptance of various evidence forms.
• Organizational and social factors significantly influenced the impact of evidence; NHS management played a minimal role.

Conclusions:

• Evidence-based medicine implementation is a complex and often contested process.
• A professional dominance model explains clinical behavior change, highlighting tacit expert knowledge as a key influence.
• Research evidence's impact on clinical practice is mediated by professional norms and social dynamics.