Knowledge to Action

Dopson, S. and Fitzgerald, L. (eds) Knowledge to Action: Evidence-based Healthcare in Context . Oxford : Oxford University Press 2005 xi + 223pp £55.00 ISBN 0-19-925901-1 (hbk) In this book the editors aim to explore why implementation of change (and evidence-based healthcare) is so difficult in professionalised organisations. The authors aim to shed light on why some attempts succeed and some fail by exploring what they call under-researched issues regarding the later stages of the creation, diffusion, and adoption of new knowledge. For example, they explore why actors use new knowledge and how they decide on legitimacy and credibility, and the significance of the social context. In doing so, the authors have built an analysis across a family of seven related research projects following attempts to introduce evidence-based healthcare in the UK in the 1990s. These research projects include ‘GRiPP-Getting Research into Practice and Purchasing’, PACE-promoting Action on Clinical Effectiveness’, Warwick Acute (Care) Study, RRTP-Relating Research to Practice, CSAG-Clinical Standards Advisory Group, Warwick Primary Care Study, and Welsh Clinical Effectiveness Initiative National Demonstration Projects. The book covers a range of different types of health-care knowledge, including clinical procedures, care pathways, and generic policies in acute and primary care settings. An introductory chapter on studying complex organisations in healthcare provides an overview of key research traditions in organisational studies. The chapter on the evidence-based healthcare and implementation gap provides a critical chronological overview of developments in the EBP movement. The chapter themes focus on professional boundaries and the diffusion of innovation, knowledge, credible evidence and utilisation, and knowledge in action. The concluding chapter outlines a social perspective on the enactment of evidence. In addition to tackling an innovative question, the book is ambitious as the authors ‘scale up’ and synthesise data from 49 case studies across the UK. The methodological discussion around how this has been done is excellent. In paying attention to the wider social context, one begins to understand why other work in this field has been limited. The authors bring together in one place a range of theoretical perspectives used in the study of complex organisations in healthcare, including medical sociology, organisational studies and anthropology, providing a sophisticated understanding of the social context, professional and power relations within which change in practice is embedded. The strength of this book is that unlike other books of this type that have paid attention to biomedical or clinical knowledge and the role of the medical professions, this book tackles health-care organisations and the range of people who work within them who are often invisible to the research gaze. In drawing on so many projects and a range of theoretical perspectives, inevitably the reader is left with wanting to find out more in-depth information than can be provided within a book of this size. There is also some frustration that theoretical perspectives are used to inform understanding of ‘what is going on’, but there are fewer attempts to challenge and contribute to theoretical bodies of work. Although there is a summary of the seven studies upon which the book is based, it would have been helpful for the publications related to these studies to have been listed. The book is aimed at academics, professionals working in public and health management, and health professionals. For those involved in the ‘knowledge business’, and changes in healthcare and the social organisation of healthcare, this book makes insightful, fascinating reading

Action (physics) · Context (archaeology) · Credibility · Health care · Political science · Public relations · Sociology · Primary Care and Health Outcomes · Psychology