Grove, Amy L., Clarke, Aileen and Currie, Graeme (2020) Knowledge mobilisation in orthopaedic surgery in England : why hierarchies of knowledge bear little relation to the hierarchy of evidence in professionally socialised groups. Evidence & Policy: A Journal of Research, Debate and Practice . doi:10.1332/174426420X16028608136504 (In Press)

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Abstract

Background: Healthcare policy encourages the use of scientific evidence in the delivery of healthcare services. However, the complexity of practice restricts the use of codified knowledge in clinical guidelines despite continued effort from policymakers to ensure their use in practice. This study adopts a knowledge mobilisation perspective to explore the multiple levels through which scientific evidence is enacted to generate variation in practice.

Aim: To explore how professionalised groups of clinicians mobilised knowledge in the highly-professionalised and organisationally-regulated context of orthopaedic surgery.

Methods: Three contrasting NHS hospitals in England were examined using case study methods from 2014–15. Data included 64 interviews with surgeons and NHS staff, nine months of observation of day-to-day practice, and collection of 121 supplementary documents. A multilevel thematic analysis and cross-case comparison explored how individual surgeons, groups of professionals and hospital organisations mobilised knowledge.

Findings: The findings described three themes to illustrate how variation in orthopaedic practice emerged: 1) professional identities; 2) knowledge acquisition; and 3) the contextual contingencies of practice. The professional groups which surgeons identified with had significant influence on how knowledge was mobilised within the organisations.

Conclusions: Knowledge owned by professionally socialised surgical groups was central to explaining variation observed in the delivery of healthcare services. Hierarchies of knowledge in the practice of orthopaedic surgery bore little relation to the hierarchy of evidence which is foundational to the production of clinical guidance and guidelines. Knowledge defined and privileged within professional surgeon groups carried significant weight in practice, and generated contingent knowledge mobilisation.

Item Type:	Journal Article
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RD Surgery
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Decision making, Orthopedics -- Decision making
Journal or Publication Title:	Evidence & Policy: A Journal of Research, Debate and Practice
Publisher:	The Policy Press
ISSN:	1744-2656
Official Date:	2020
Dates:	Date Event 2020 Published 9 November 2020 Available 9 November 2020 Accepted
DOI:	10.1332/174426420X16028608136504
Status:	Peer Reviewed
Publication Status:	In Press
Publisher Statement:	This is a post-peer-review, pre-copy edited version of an article published in Evidence & Policy: A Journal of Research, Debate and Practice. The definitive publisher-authenticated version Grove, Amy L., Clarke, Aileen and Currie, Graeme (2020) Knowledge mobilisation in orthopaedic surgery in England : why hierarchies of knowledge bear little relation to the hierarchy of evidence in professionally socialised groups. Evidence & Policy: A Journal of Research, Debate and Practice. is available online at: http://dx.doi.org/10.1332/174426420X16028608136504
Access rights to Published version:	Restricted or Subscription Access

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