Background: Healthcare policy encourages the use of scientific evidence in clinical practice. The complex reality of practice means that dissemination of this evidence in clinical guidelines is insufficient to change behaviour and reduce variation. This study took a knowledge mobilisation perspective to assess the role of evidence- based medicine in orthopaedic practice decisions for hip replacement surgery. Objectives: The research sought to identify where, when and how evidence and knowledge were used in decision-making and how this contributed to variation in practice. It discovered factors which influenced orthopaedic surgery decision-making through an in-depth exploration of real life evidence use in practice. Methods: Three in-depth case studies were conducted at NHS hospitals over 12-months. Data collected included 64 interviews with surgeons and NHS staff, observations of day-to-day practice and the collection of 121 supplementary documents. A case study road map method was performed using thematic analysis to generate four themes: individuals, groups, organisations and regulation. Results: The findings combined individuals and groups, the organisational dynamics and environmental regulation to provide a nuanced understanding of knowledge mobilisation in orthopaedics. Group level knowledge was crucial in explaining variation to evidence based medicine, specifically how it influenced organisational capacity and the socialisation of medical professionals. The characteristics of surgeons also contributed to the wider definition of evidence which was important for clinical decisions. Conclusion: This empirical study of knowledge mobilisation demonstrated that orthopaedic practice was contingent and mediated at different levels, each of which contributed to variation. Decision-making was dependent on a range evidence and knowledge sources that were influential across the entire knowledge domain. A conceptual framework was produced to demonstrate how knowledge is mobilised in a highly professionalised organisationally regulated context.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:737712 |
| Date | January 2017 |
| Creators | Grove, Amy L. |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/99177/ |
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