 |
From Research Evidence to ‘Evidence by Proxy’? Organizational Enactment of Evidence-Based Healthcare
|
Author: Roman Kislov, U. of Manchester
Author: Paul Wilson, U. of Manchester
Author: Greta Cummings, U. of Alberta
Author: Anna Ehrenberg, Dalarna U.
Author: Wendy Gifford, U. of Ottawa
Author: Janet Kelly, U. of Adelaide
Author: Alison Kitson, Flinders U.
Author: Lena Petterson, Dalarna U.
Author: Lars Wallin, Dalarna U.
Author: Gill Harvey, U. of Adelaide
|
|
|
|
|
|
|
|
Drawing on multiple qualitative case studies of evidence-based healthcare conducted in Sweden, Canada, Australia and the UK, we systematically explore the composition, circulation and role of codified knowledge deployed in the organizational enactment of evidence-based practice. We describe the ‘chain of codified knowledge’, reflecting the institutionalization of evidence-based practice as organizational ‘business as usual’, and show that it is dominated by performance standards, policies and procedures, and locally collected (improvement and audit) data. These interconnected forms of ‘evidence by proxy’, which are informed by research partly or indirectly, enable simplification, selective reinforcement and contextualization of scientific knowledge. Our analysis reveals dual effects of this codification dynamic on evidence-based practice and highlights the influence of macro-level ideological, historical and technological factors on the composition and circulation of codified knowledge in the organizational enactment of evidence-based healthcare in different countries.
|
|
|
|
Paper is No Longer Available Online: Please contact the author(s).
|
|
|
|
|
Listening and Learning: A Case for Indigenous Conceptualizations of the Learning Health System
|
Author: Crystal Milligan, U. of Toronto, Institute of Health Policy, Management & Evaluation
|
|
|
|
|
|
|
|
Mainstream health systems fail to support Indigenous peoples’ health and must be reorganized with guidance from Indigenous knowledges and ways of knowing if they are to gain relevance and address the holistic needs of Indigenous communities. As a health system model that could learn from Indigenous ways of knowing, the learning health system (LHS) has potential to facilitate and sustain not only the delivery of health services that incorporate Indigenous knowledges and ways of knowing, but also ongoing processes of generative learning and reinvention. Built on respectful, trusting relationships between knowledge holders within and beyond porous organizational boundaries, the LHS could be developed as an inclusive system that contributes to Indigenous self-determination and, ultimately, better health and healthcare. Drawing from a northern Canadian context, this paper integrates Indigenous and Western discourses to deepen our understanding of the concepts of learning, health and systems, and how the LHS may add value beyond the sum of these parts. There is a need for research to privilege Indigenous voice and leadership to enhance and deepen evolving conceptualizations of the LHS and of healthcare more broadly.
|
|
|
|
Paper is No Longer Available Online: Please contact the author(s).
|
|
|
|
|
|
The Use of Performance Feedback Information by Primary Care Organizations: Learning Gatekeepers?
|
Author: Gijs Brouwer, Maastricht U.
Author: Daan Westra, Maastricht U.
Author: Federica Angeli, Tilburg U.
Author: Ruben Roomans, Maastricht U.
Author: Dirk Ruwaard, Maastricht U.
|
|
|
|
|
|
|
|
Background Emphasizing the gatekeeper role of primary care organizations is a strategy to reduce healthcare costs in several systems. Performance of primary care organizations can consequently be operationalized in terms of their effectiveness as gatekeepers and primary care organizations receive performance feedback regarding their performance as gatekeepers. Even though it is crucial for a well-functioning primary care system, it is unclear how primary care organizations respond to this type of benchmarking, Purpose To explore the attention for- and response of primary care organizations to performance feedback information of their gatekeeping performance. Methodology/Approach We conducted a survey, including closed questions, open questions, and vignettes, among all primary care practices that utilized performance feedback information of their gatekeeping performance between 2015 and 2018 in the Netherlands. Results The results indicate that the majority of general practitioners consider and comprehend performance feedback information regarding their gatekeeping performance. Although a practice’s performance relative to the aspiration level determines an organization’s response to the feedback information, respondents consider the performance feedback information untimely, and not sufficiently aligned with their organizational goals. Conclusion The performance–response relationship of performance feedback information regarding gatekeeping performance follows existing theory on organizational learning. Furthermore, responses to performance below aspiration levels are undertaken on a longer term. However, primary care organizations emphasize goals within their own domain of primary care rather than those associated to their gatekeeping role. Organizational learning from performance feedback information regarding gatekeeping performance thus seems to be limited. Practice Implications Benchmarking the gatekeeping performance of primary care organizations seems to have limited effects. Primary care organizations should be made more aware of their goals as gatekeepers in order to improve organizational learning from such performance feedback information.
|
|
|
|
Paper is No Longer Available Online: Please contact the author(s).
|
|
|
|
|
Epistemic Influences on Knowledge Translation in Healthcare: The Mediating Role of Social Networks
|
Author: Harry Scarbrough, City U. London
Author: Jacky Swan, U. of Warwick
|
|
|
|
|
|
|
|
Previous work has highlighted the direct effect of epistemic differences between groups on knowledge translation work. In this paper, we ask whether such differences in the 'ways of knowing' amongst expert groups may also have an indirect effect on knowledge translation efforts by shaping the social network ties which are formed between groups. Our empirical study of a major knowledge translation initiative in the English NHS (National Health Service) is based on a social network analysis of the ties between groups. It shows that epistemic differences are reflected in homophilous patterns of social ties - i.e. members of expert groups tending to share knowledge with each other. Academic groups, and especially social scientists, exhibit more inward-looking patterns of networking. Individuals with multi- disciplinary expertise were found to be more likely to act as the boundary-spanners between groups. Over time, members of the health sciences discipline helped to provide a bridge between social scientists and healthcare practitioner groups (clinicians and managers). Our study makes several contributions to theoretical and practical understandings of knowledge translation in healthcare by not only showing how epistemic differences may indirectly impact such work via their structuring of social networks, but also providing evidence on the multi-disciplinary expertise in determining the boundary-spanning position of individuals.
|
|
|
|
Paper is No Longer Available Online: Please contact the author(s).
|
|
|
|
|