Implementing findings of research

Haines, Andy; Jones, Roger

doi:10.1136/bmj.308.6942.1488

Cited by 353 publications

(194 citation statements)

References 34 publications

(26 reference statements)

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“…Rosen and Gabbay (1999) found that managers were unimpressed by technical advantages, and evaluated a new technology in terms of its impact on the organization. Operational staff need to understand what a technology aims to do (Williamson, 1992), perceive an innovation as capable of improving outcomes or processes (Haines and Jones, 1994), and recognize its relevance and validity within a specific setting (Shaugnessy et al, 1994). Wood et al's (1998) study of four innovative health technologies found that innovation was 'neither natural nor inevitable, but constantly negotiated and aligned … within an assemblage of scientific and organisational and behavioural factors ' (1998: 1734-5).…”

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confidence: 99%

Boundary Objects, Social Meanings and the Success of New Technologies

2011

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Boundary objects are entities that enhance the capacity of an idea, theory or practice to translate across culturally defined boundaries, for example, between communities of knowledge or practice. This concept thus has potential to both explain and predict technology adoption; however, it remains sociologically under-theorized. This article assesses, by recourse to a historical case study of innovations in surgical sterility, how boundary objects work and their relationship to social meanings within communities of practice. It is concluded that not only are there positive and negative boundary objects, but that technological devices or processes may themselves act as facilitative or inhibitory boundary objects during innovation. The approach set out here has potential as a sociologically informed model of improving adoption of technologies and policies by managing the positive and negative social meanings of technology objects.

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confidence: 99%

Boundary Objects, Social Meanings and the Success of New Technologies

2011

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“…The audit model used current evidence on changing and improving clinical practice (Grimshaw et al, 1993;Haines et al, 1994). There is substantial evidence that physicians are more likely to change their practice if guidelines are local rather than national, if opinion leaders spread the guidelines, if there is wide participation in the setting of standards, if there is feedback about the results and face-to-face discussion of management standards (Greco et al, 1993;Grimshaw et al, 1993;Haines et al, 1994).…”

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Breast cancer management: is volume related to quality?

Bell²,

Campbell³

et al. 1997

Br J Cancer

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Summary A method of carrying out region-wide audit for breast cancer was developed by collaboration between the cancer registry, providers and purchasers as part of work to fulfill the 'Calman-Hine' recommendations. In order to test the audit method, a retrospective audit in North Thames East compared practice in 1992 against current guidelines. The analysis compared care in specialist and non-specialist centres. A stratified random sample comprising 28% of all breast cancer patients diagnosed in 1992 was selected from the population-based Thames Cancer Registry. The data for 309 patients with stage I-Ill tumours were analysed by hospital type using local guidelines. No difference between specialist (high volume) and non-specialist centres was detected for factors important in survival. Pathological staging was good with over 70% reporting tumour size and grade. A small number of patients were undertreated; after conservative surgery, 10% (19) of women did not receive radiotherapy, and 15% (8) of node-positive premenopausal women did not receive chemotherapy or ovarian ablation. In contrast, a significant trend with hospital volume was found for several quality of life factors. These included access to a specialist breast surgeon and specialist breast nurses, availability of fine-needle aspiration (FNA), which ranged from 84% in high-volume to 42% in low-volume centres, and quality of surgery (axillary clearance rates ranged from 51% to 8% and sampling of less than three nodes from 3% to 25% for high-and very low-volume centres respectively). Confidential feedback of results to surgeons was welcomed and initiated change. The summary information gave purchasers information relevant to the evaluation of cancer services. While the audit applied present standards to past practice, it provided the impetus for prospective audit of current practice (now being implemented in North Thames).

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“…Alternatively, the failure to update the policies may reflect the difficulty of translating research evidence into practice. Many barriers to the implementation of research into clinical practice are recognised [13,14], including cognitive factors, the attitudes of physicians, the social and organisational context in which the evidence is presented and the economic context. With other innovations, such as the implementation of therapeutic hypothermia after cardiac arrest, a typical lag-time of five years is seen between the publication of the guideline and widespread integration into clinical practice [15].…”

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confidence: 99%

Changing practice with changing research: results of two UK national surveys of intensive insulin therapy in intensive care patients*

Paddle¹,

Eve

Sharpe

2011

Anaesthesia

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Summary We conducted two telephone surveys of all United Kingdom adult intensive care units in 2007/8 and 2010 to assess practice with regard to intensive insulin therapy for glycaemic control in critically ill patients, and to assess the change in practice following publications in 2008 and 2009 that challenged the evidence for this therapy. Of 243 units that had a written policy for intensive insulin therapy in 2007/8, 232 (96%) still had a policy in 2010. One hundred and six (46%) units had updated their policy in response to new evidence, whereas 126 (54%) stated that it had remained the same. Where intensive care units had changed their policy, we found a significant increase in target limits and a wider target range. Regional variations in practice were also seen. Across seven regions, the percentage of units where the glycaemic control policy had been updated since 2007/8 varied from nil to 78.9%.

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Implementing findings of research

Cited by 353 publications

References 34 publications

Boundary Objects, Social Meanings and the Success of New Technologies

Boundary Objects, Social Meanings and the Success of New Technologies

Breast cancer management: is volume related to quality?

Changing practice with changing research: results of two UK national surveys of intensive insulin therapy in intensive care patients*

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