Huw Davies, PhD

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Understanding Research Use in Health Care
Management

• Huw Davies, PhD
• Centre for Public Policy Management
• University of St Andrews

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Research Unit for Research Utilisation
(RURU) Huw Davies, Sandra Nutley,
Isabel Walter Jen Morton, Joyce
Wilkinson, Tobias Jung
many downloadables at
www.st-and.ac.uk/ruru
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What IS research use? What IS research
impact? How can use/impact be facilitated?
CEO
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At the core of Evidence-Based Management is the
notion that health care managers should
incorporate into their decision making the best
available research.
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Managerial decision making

• SOMETIMES
• clearly defined event
• explicit decisions
• conscious deliberation
• defined policies
• policy fixed at implementation

• OFTENTIMES
• ongoing process
• piecemeal no single decision
• muddling through
• policies emerge and accrete
• shaped through implementation

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A research use continuum
CONCEPTUAL USE
INSTRUMENTAL
Impacts on organisational outcomes? Different
strategies for different ends?
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NOT Evidence-based but Evidence-influenced...
or even just Evidence-aware?
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A map of the terrain
Types of knowledge
Types of research utilisation
EBMan
Conceptual Frameworks
Models of process
Implementation interventions
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Types of knowledge
Types of research utilisation
Knowledge content What works (know-what)
but also Know-about (problems) Know-how (to put
into practice) Know-who (to involve) Know-why
(impetus to action)
EBMan
Knowledge form Explicit Knowledge -
research - routine data Tacit Knowledge
Conceptual Frameworks
Models of process
Implementation interventions
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Types of knowledge
Types of research utilisation
EBMan

• Instrumental or conceptual?
• Underuse, overuse misuse?
• Replication or innovation?

Conceptual Frameworks
Models of process
Implementation interventions
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Types of knowledge
Types of research utilisation
EBMan

• Research into management (simple)
• Emphasis on linearity logic
• Two Communities paradigm
• Dissemination/KT elements
• Source (e.g. perceived competence)
• Content (e.g. fit with existing practice)
• Medium (e.g. timeliness, accessibility)
• User (e.g. capacity to use information)

Conceptual Frameworks
Models of process
Implementation interventions
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Types of knowledge
Types of research utilisation
EBMan

• Research into management (complex)
• Manager as learner
• Emphasis on complex adaptive systems
• Implementation as cultural change

Conceptual Frameworks
Models of process
Implementation interventions
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Types of knowledge
Types of research utilisation
EBMan
Research into management

• Research in management
• Challenges any neat separation between
  research and practice
• Emphasises the social construction of
  knowledge and the role of power
• Analyses the EBEverything discourse

Conceptual Frameworks
Models of process
Research in management
Implementation interventions
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Types of knowledge
Types of research utilisation
Diffusion of innovations Institutional
theory Change management Knowledge
management Individual learning Organisational
learning
EBMan
Conceptual Frameworks
Models of process
Implementation interventions
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What works in getting better research use
impact?
Types of knowledge
Types of research utilisation

• No magic bullets
• Even good passive dissemination is not enough
• Active interventions are required
• informed by diagnosis of barriers to change
• Multifaceted multilevel approaches seem best
• Some evidence to support partnership working

EBMan
Conceptual Frameworks
Models of process
Implementation interventions
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Partnership working no easy ride
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Research-savvy managers?

• Understanders of context
• Knowledgeable on the research base
• Managers of complex relationships
• Skilled at information management
• Grounded in economics, statistics and social
  science
• Strong project management ability
• Presentational and communication skills
• Adaptive, continually learning

UK Cabinet Office, 1999
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Take home messages

• There is scope for improved evidence-informed
  health care management - especially within
  modified organisational processes.
• For improved impacts
• Develop enlightenment impacts
• Translate/tailor the evidence
• Expect local adaptation and tinkering
• Shape the local context
• Secure active engagement throughout
• Deepen partnership working

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Evidence based management? Some way to go