Objectives-To describe the relation between research evidence and local obstetric unit policy for specific areas of care and to explore clinicians' views about the reasons for any discrepancies identified.
Major differences exist in the approaches taken by MAAGs and the roles they fulfil, which will make evaluation of their effectiveness a complex task. Already MAAGs are responding to changing expectations about audit and pressure for closer links with management.
Independent qualitative evaluation of a project designed to ensure that clinical policy in specific areas of care in three obstetric units within one English health district was based on authoritative evidence. Data from nonparticipant observation, interviews, questionnaires and documents were combined to generate a description of what the project involved and analyses from the perspectives of two key groups of stakeholders: the project proponents and the unit staff whose policies the project was intended to address. Key aspects of the project are examined from these perspectives to elucidate the assumptions of those involved in the project design and assess the adequacy of their attempts to facilitate success. Attempts were made to meet many of the accepted criteria for effective implementation. Nevertheless, the majority of unit staff retained significant doubts about the validity of the project's starting point and the approach adopted. The project process was followed as anticipated. After one year the intended work programme had been completed. The proponents saw the project as quite successful; they were unaware of the extent of the reservations still held by unit staff. The proponents focused on potential barriers that 'made sense' in the light of their own values and priorities. Failure to recognize the actual causes of concern was due to not hearing or listening to unit staff. Intended strengths of the project design were viewed quite differently by staff because they did not share the proponents' basic premises. Approaches to promoting evidence-based practice which take account of the views of all parties regarding problems and solutions are more likely to succeed.
Objectives-To investigate perceptions of family health service authorities and medical audit advisory groups of advisory groups' involvement in clinical audit and wider quality issues; communication with the authorities; and manager satisfaction. Design-National postal questionnaire survey in 1994.Setting-AUl family health services authority districts in England and Wales.
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