AIMS AND CONTEXT OF THE STUDY
The rise of evidence-based healthcare and the challenges of translating research into practice have focused attention on improving the ways in which healthcare managers exploit evidence in their decision making. Significant efforts have been devoted to developing tools, guidelines and information systems to capture and transfer ‘evidence’. Research, however, continues to show poor diffusion of ‘evidence’ across managers of NHS organizations and patchy uptake of knowledge products.
These problems of knowledge utilization are particularly challenging in Primary Care Trusts’ (PCTs) commissioning decisions. PCT spending accounts for 75% (£69 billion) of the NHS budget in England (DH, 2008) and yet there is significant variation in spending patterns, only partly explicable by local population needs (King’s Fund, 2008). By highlighting ‘unanswered questions about why PCTs reach different decisions about their spending priorities’, the Kings Fund work stresses the need to better understand the utilization of evidence in commissioning. This need is underlined by major efforts to systematize the commissioning process such as the recently announced World Class Commissioning programme (DH, 2007).
Our research proposes a fundamental shift towards viewing ‘evidence’ as being co-produced and utilized through the interacting practices of a range of professional and managerial groups, including commissioning managers, public health experts, finance managers and clinicians.
1. To provide greater understanding of knowledge utilization in healthcare management by analysing the co-production of evidence by different groups within PCTs’ commissioning decisions.
2. To explain how and why the available knowledge products aimed at managers are synthesized and applied (or not) within the commissioning process, in order to identify how such products might be more effectively configured for demand and use.
3. To analyse the way in which different managerial groups interact in co-producing evidence for commissioning decisions so as to identify: (i) the roles of inter-group contestation/ collaboration, and; (ii) the micro-dynamics of knowledge utilization, where evidence for decision-making emerges from the exchange of material objects (including knowledge products) within the framing supplied by discourses and policies.
4. To develop a comparative theoretical framework, derived from multiple case contexts, which links the roles played by different groups in the co-production of evidence to the process of PCT commissioning, helping to explain variation across PCTs.
5. To develop practical guidance for policy makers and managers on knowledge utilization in commissioning by engaging stakeholder groups in all stages of the research (PCT Managers, NHS Evidence - National Knowledge Service (NKS), the National Library for Health (NLH) - NHS Institute, King’s Fund, Dept of Health and academics).