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The relatively recent attention that evidence-based decision making has received in health care management has been at least in part due to the profound influence of evidence-based medicine. The result has been several comparisons in the literature between the use of evidence in health care management decisions and the use of evidence in medical decision making. Direct comparison, however, may be problematic, given the differences between medicine and management as they relate to (1) the nature of evidence that is brought to bear on decision making; (2) the maturity of empirical research in each field (in particular, studies that have substantiated whether or not and how evidence-based decision making is enacted); and (3) the context within which evidence-based decisions are made. By simultaneously reviewing evidence-based medicine and management, this chapter aims to inform future theorizing and empirical research on evidence-based decision making in health care settings.

The rise of evidence‐based medicine and more recently evidence‐based policy reflect the increasing importance of evidence as a basis for the organisation and delivery of health care. Evidence‐based practice is central to the “modernisation” of health care in current UK policy. The latest manifestation of this process is the emergence of evidence‐based management in health care. This paper examines the development of evidence‐based approaches in health care and questions the appropriateness of such an approach to management. The problems inherent in applying the principles of EBP to management are explored and alternative apporoach based on the notion of craft is suggesteed as more practical and realistic.

Evidence-based practice is pivotal to effective patient care. However, its translation into practice remains limited. Given the central role of primary care in many healthcare systems, it is important to identify strategies that bolster clinician-capacity to promote evidence-based care. The purpose of this paper is to identify strategies to increase Practice Nurse capacity to promote evidence-based sexual healthcare within general practice.

A survey of 217 Practice Nurses in an Australian state and ten respondent-interviews regarding two resources to promote evidence-based sexual healthcare – namely, a clinical aide and online training.

The perceived impact of both resources was determined by views on relevance and design – particularly for the clinical aide. Resource-use was influenced by role and responsibilities within the workplace, accessibility, and support from patients and colleagues.

This is the first Australian study to reveal strategies to promote evidence-based sexual healthcare among Practice Nurses. The findings provide a platform for future research on knowledge translation processes, particularly among clinicians who might be disengaged from sexual healthcare.

Given the benefits of evidence-based practices, it is important that managers recognize their role, and the role of their services, in promoting these. Without explicit support for evidence-based care and recognition of the Practice Nurse role in such care, knowledge translation is likely to be limited.

Knowledge translation among Practice Nurses can be facilitated by: resources-deemed informative, relevant, and user-friendly, as well as support from patients, colleagues, and their workplace.

What does evidence‐based health care add to the numerous initiatives in the UK over the last 10 years to improve the quality, effectiveness and efficiency of health care? The health care research and development industry has evolved into a patchwork of activities — clinical audit, clinical effectiveness, health services research, health outcomes, health technology assessment, quality in health care, clinical guidelines, systematic reviews, and medical informatics — with many blurred boundaries. Is evidence‐based health care just an old product in a new package, or does it offer new concepts?

Important shifts in policy and practice, the shift to woman‐centred services, the recognition that midwives should be lead clinician in a number of cases, and the idea of effective care, are leading to fundamental change in the maternity services. For many years, midwives have shown interest in the idea of evidence‐based or effective care. There are a number of good reasons for the interest in evidence‐based care. However, unless the political reality of the difficulties of the change are faced, the changes will remain rhetorical, virtual rather than real. Midwifery holds the potential for using evidence in practice, and for improving health outcomes for mothers and babies. If the status quo is not challenged, an important opportunity will have been missed.

The dynamics of the physician knowledge system in the Southern California Region of Kaiser Permanente are explored. The framing and analysis use concepts from the knowledge management literature and network theory. The criticality of this issue to the establishment of sustainable healthcare relates to the lynchpin nature of embedding evidence-based knowledge in healthcare practice and the simultaneous challenge of combining this with clinical knowledge that derives from practice.

The case study is compiled from longitudinal interviews with over 40 physicians and other stakeholders and an examination of archival information including published articles generated by the learning system.

The socio-technical approach to building this learning system was critical given the expectations of physicians for autonomy in making clinical decisions with respect to their patients. This robust learning system builds on rich professional and organizational networks, is led by physicians, and builds on and extends the foundation of evidence relating to quality and value. The goals of the physician practice and a robust measurement and feedback system provide focus for the learning system.

Accelerating the incorporation of evidence-based practice and increasing the scope and reach of the learning system entails building physician networks, having a robust system for critically examining and extending evidence, and a clear linkage to valued outcomes.

This detailed examination of the dynamics of knowledge absorption extends understanding of the capacity of medical care systems to absorb evidence-based knowledge.

The demand for evidence‐based health practices has created a cultural challenge for Indigenous people around the world. This paper reports on the history and evolution of evidence‐based care into its mainstream status within the behavioural health field. Through the leadership of an Alaska Native tribal organisation, an international forum was convened to address the challenges of evidence‐based practice for Indigenous people. Forum participants developed a model for gathering evidence that integrates rigorous research with Indigenous knowledge and values. The model facilitates development of practices and programmes that are culturally congruent for Indigenous people, accepted and validated by the research community, and deemed supportable by private and governmental sponsors.

The evidence‐based practice (EBP) model appears to have established itself as the principal change driver and discourse for the healthcare sector. This study sets out to identify the emergence of the term EBP in the professional literature to establish an empirical foundation for discussion. The understanding of and relevance to healthcare practitioners in a large South West London hospital are assessed and their views related to the perspective of library and information professionals to assess implications for practice.

An extensive literature search was carried out and the data generated used to produce a growth curve for the literature. A survey of health care professionals using e‐mail and follow‐up interviews was undertaken at the case hospital.

Between 1998 and 2004 the number of papers appearing to discuss the theme increased four‐fold. The first recorded reference was in 1991. The EBP model had strong official and political support in the field. On the user sample there is evidence of resistance to the orthodoxy.

The EBP model – variously adopted by several healthcare agencies – has placed information management at the centre of the care process. In spite of this, there are few definite implications for the role of library and information professionals, since the world of information and the UK NHS itself are continually in a state of flux, and the current EBP dominance may neither strengthen nor safeguard it.

The bibliometric study provides a baseline. The study of healthcare professionals is a case study to add to knowledge of practice.

Presents models suggesting how research evidence can best be operationalised within health care commissioning. Models were derived from data gathered from surveys of Scottish health board managers and GP fundholders regarding the use of information in commissioning from 1995 to 1997. Feedback on the models was obtained subsequently from practitioners in 1998. Two models, one for health board managers and the other for GPs, are presented. These include critical success factors in achieving evidence‐based commissioning and factors that are likely to predispose and precipitate evidence‐based practice. Given a culture demanding transparency, accountability and continuing improvement, the models provide tools for reflection, evaluation and planning. In addition, they identify a pragmatic role for managers in evidence‐based commissioning and provide a framework for audit.

In 1996 and 1997 authoritative reports identified the absence of a research culture in primary care. This article reviews progress since then in the context of the wider development of evidence based medicine. The article considers critiques of the meaning of evidence and focuses on both service delivery and policy. An argument is made that “knowledge”, “not evidence”, offers a better basis for primary care practice.