In the eye of the beholder: problems of perception in designing a strategy to promote evidence‐based clinical policy

Abstract

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.

The process of research use in nursing

“…Models of research use also need to reflect the importance of a common framework in understanding uncertain situations from both a research and a practice perspective. Problem definition is crucial (Humphrey & Berrow 2000).…”

Seeking evidence from medical research consumers as part of the medical research process could improve the uptake of research evidence

“…Humphrey & Berrow (2000) identify preconceptions about practitioners as an issue. They observed during an EBM clinical policy implementation project that there was an underlying assumption about practitioners that their failure to comply with evidence was not a matter of considered or rational choice, but could be explained rather in terms of deficits of one kind or another, i.e.…”

“…Humphrey & Berrow (2000, p. 171) also recorded that there was an issue with the lack of congruence between topics that were the subject of medical research and those that were of interest to practitioners and patients. They observed that scientific knowledge and local concern were ‘generated for very different reasons’.…”

Antipsychotics for aggressive adolescents: barriers tobest practice

“…Barriers to implementing evidence-based treatments have been addressed in other domains of medicine [44][45][46]. Emphasis must also be placed on the use of an evaluative process to assess the results of implementation efforts [49]. They also emphasize the importance of the information being delivered, how and to whom.…”