Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in health care.
File(s)
Published version
Author(s)
Kyratsis, Y
Ahmad, R
Hatzaras, K
Iwami, M
Holmes, AH
Type
Journal Article
Abstract
Background: Although innovation can improve patient care, implementing new ideas is often challenging.
Previous research found that professional attitudes, shaped in part by health policies and organisational
cultures, contribute to differing perceptions of innovation ‘evidence’. However, we still know little about
how evidence is empirically accessed and used by organisational decision-makers when innovations
are introduced.
Aims and objectives: We aimed to investigate the use of different sources and types of evidence in
innovation decisions to answer the following questions: how do managers make sense of evidence? What
role does evidence play in management decision-making when adopting and implementing innovations in
health care? How do wider contextual conditions and intraorganisational capacity influence research use
and application by health-care managers?
Methods: Our research design comprised multiple case studies with mixed methods. We investigated
technology adoption and implementation in nine acute-care organisations across England. We employed
structured survey questionnaires, in-depth interviews and documentary analysis. The empirical setting was
infection prevention and control. Phase 1 focused on the espoused use of evidence by 126 non-clinical
and clinical hybrid managers. Phase 2 explored the use of evidence by managers in specific technology
examples: (1) considered for adoption; (2) successfully adopted and implemented; and (3) rejected
or discontinued.
Findings: (1) Access to, and use of, evidence types and sources varied greatly by profession. Clinicians
reported a strong preference for science-based, peer-reviewed, published evidence. All groups called upon
experiential knowledge and expert opinion. Nurses overall drew upon a wider range of evidence sources
and types. Non-clinical managers tended to sequentially prioritise evidence on cost from national-level
sources, and local implementation trials. (2) A sizeable proportion of professionals from all groups,
including experienced staff, reported difficulty in making sense of evidence. Lack of awareness of existing
implementation literature, lack of knowledge on how to translate information into current practice, and
lack of time and relevant skills were reported as key reasons for this. (3) Infection outbreaks, financial
pressures, performance targets and trusted relationships with suppliers seemed to emphasise a pragmatic
and less rigorous approach in sourcing for evidence. Trust infrastructure redevelopment projects,
and a strong emphasis on patient safety and collaboration, appeared to widen scope for evidence use.
(4) Evidence was continuously interpreted and (re)constructed by professional identity, organisational role, team membership, audience and organisational goals. (5) Doctors and non-clinical managers sourced
evidence plausible to self. Nursing staff also sought acceptance of evidence from other groups. (6) We
found diverse ‘evidence templates’ in use: ‘biomedical-scientific’, ‘practice-based’, ‘rational-policy’. These
represented shared cognitive models which defined what constituted acceptable and credible evidence in
decisions. Nurses drew on all diverse ‘templates’ to make sense of evidence and problems; non-clinical
managers drew mainly on the practice-based and rational-policy templates; and doctors drew primarily on
the biomedical-scientific template.
Conclusions: An evidence-based management approach that inflexibly applies the principles of
evidence-based medicine, our findings suggest, neglects how evidence is actioned in practice and how
codified research knowledge inter-relates with other ‘evidence’ also valued by decision-makers. Local
processes and professional and microsystem considerations played a significant role in adoption and
implementation. This has substantial implications for the effectiveness of large-scale projects and
systems-wide policy.
Previous research found that professional attitudes, shaped in part by health policies and organisational
cultures, contribute to differing perceptions of innovation ‘evidence’. However, we still know little about
how evidence is empirically accessed and used by organisational decision-makers when innovations
are introduced.
Aims and objectives: We aimed to investigate the use of different sources and types of evidence in
innovation decisions to answer the following questions: how do managers make sense of evidence? What
role does evidence play in management decision-making when adopting and implementing innovations in
health care? How do wider contextual conditions and intraorganisational capacity influence research use
and application by health-care managers?
Methods: Our research design comprised multiple case studies with mixed methods. We investigated
technology adoption and implementation in nine acute-care organisations across England. We employed
structured survey questionnaires, in-depth interviews and documentary analysis. The empirical setting was
infection prevention and control. Phase 1 focused on the espoused use of evidence by 126 non-clinical
and clinical hybrid managers. Phase 2 explored the use of evidence by managers in specific technology
examples: (1) considered for adoption; (2) successfully adopted and implemented; and (3) rejected
or discontinued.
Findings: (1) Access to, and use of, evidence types and sources varied greatly by profession. Clinicians
reported a strong preference for science-based, peer-reviewed, published evidence. All groups called upon
experiential knowledge and expert opinion. Nurses overall drew upon a wider range of evidence sources
and types. Non-clinical managers tended to sequentially prioritise evidence on cost from national-level
sources, and local implementation trials. (2) A sizeable proportion of professionals from all groups,
including experienced staff, reported difficulty in making sense of evidence. Lack of awareness of existing
implementation literature, lack of knowledge on how to translate information into current practice, and
lack of time and relevant skills were reported as key reasons for this. (3) Infection outbreaks, financial
pressures, performance targets and trusted relationships with suppliers seemed to emphasise a pragmatic
and less rigorous approach in sourcing for evidence. Trust infrastructure redevelopment projects,
and a strong emphasis on patient safety and collaboration, appeared to widen scope for evidence use.
(4) Evidence was continuously interpreted and (re)constructed by professional identity, organisational role, team membership, audience and organisational goals. (5) Doctors and non-clinical managers sourced
evidence plausible to self. Nursing staff also sought acceptance of evidence from other groups. (6) We
found diverse ‘evidence templates’ in use: ‘biomedical-scientific’, ‘practice-based’, ‘rational-policy’. These
represented shared cognitive models which defined what constituted acceptable and credible evidence in
decisions. Nurses drew on all diverse ‘templates’ to make sense of evidence and problems; non-clinical
managers drew mainly on the practice-based and rational-policy templates; and doctors drew primarily on
the biomedical-scientific template.
Conclusions: An evidence-based management approach that inflexibly applies the principles of
evidence-based medicine, our findings suggest, neglects how evidence is actioned in practice and how
codified research knowledge inter-relates with other ‘evidence’ also valued by decision-makers. Local
processes and professional and microsystem considerations played a significant role in adoption and
implementation. This has substantial implications for the effectiveness of large-scale projects and
systems-wide policy.
Date Issued
2014-03-01
Date Acceptance
2014-01-06
Citation
Health Services and Delivery Research, 2014, 2 (6)
ISSN
2050-4357
Publisher
NIHR Health Technology Assessment Programme
Journal / Book Title
Health Services and Delivery Research
Volume
2
Issue
6
Copyright Statement
© Queen’s Printer and Controller of HMSO 2014. This work was produced by Kyratsis et al. under the terms of a commissioning
contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and
study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement
is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be
addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre,
Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and
study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement
is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be
addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre,
Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
Sponsor
Medical Research Council (MRC)
Medical Research Council (MRC)
National Institute for Health Research
National Institute for Health Research
Grant Number
G0800777
G0800777
HPRU-2012-10047
HPRU-2012-10047
Publication Status
Published
Article Number
25642560