From surveys, interviews, focus groups and observational research of different kinds, we have learned that managers rarely seek formal, research-based information from academic journals or other sources.
A study by Sue Dopson in 2013 used comparative case studies in six health settings to look at the use of management and organisational evidence. Findings suggest health care managers are most oriented towards knowledge from their own experience and that of their communities of practice.
“Research often offers answers for healthcare providers and clinicians easier than commissioners, as it is more black and white – is drug A better than drug B? As commissioners, we have thornier issues, such as what one or two interventions are going to make the greatest impact for the population we serve? Is it affordable? How do we implement it effectively?”
Rachel Anthwal, Bristol Clinical Commissioning Group
Formal research-based knowledge and management journals were the lowest source of influence. Given the importance of knowledge by experience, the study confirmed the value of formative spaces like action learning sets. These provided a space for reflection where managers can 'transpose' knowledge into practice.
Another study by Christine Edwards in 2013 combined case research in five sites with a large survey of over 2000 managers in commissioning and provider organisations. Over two thirds of respondents found it difficult to access information. As well as reinforcing the importance of learning by personal experience, both studies show the way managers access and use evidence is complex and non-linear. This does not fit well with existing models for providing information in formal 'products’ or library type evidence services.
Similarly, a project by Jacqueline Swan in 2012 looked at how commissioning managers, public health experts, finance managers and clinicians used information. Survey results showed the source of evidence most used in commissioning decisions was local public health intelligence and examples of good practice from other healthcare sites.
A key finding was that 'evidence does not speak for itself', but needs to be mobilised by the right people, at the right time, to affect decisions. The Swan study found that knowledge does not exist independently as intact products, but emerges through 'co-production' by managers in their own networks and groups, who make sense of key findings and frame evidence around local context and real issues. This chimes with the useful notion of clinical 'mindlines' or communities of peers creating and building knowledge (Gabbay and LeMay 2004).
Traditional ways that researchers share findings are not likely to work for decision-makers in health and care. One rich comparative case study of four commissioning organisations by Lesley Wye in 2015 found that managers drew on a wide range of sources to make decisions. These included best practice guidance, local expert views and examples from other sites. Little evidence was drawn from academic research.
Local data and evaluations seemed to trump national or formal research-based information. Managers selected evidence pragmatically to make the best case for action. They conveyed information through conversations and stories, best suited to fast-paced decisions.
“Researchers like to write, but commissioners like to talk. Through conversations, discussions and stories, commissioners can get timely, relevant, adaptable, contextually-specific information quickly. This suits their information needs and working environment.”
Lesley Wye, Senior Research Fellow, University of Bristol