Louise FitzGerald

The role of the middle manager in the implementation of evidence‐based health care

The present study reflects on the role of the middle manager in the implementation of what has become known as evidence-based health care. This movement advocates that clinical practice is continually informed by the results of robust research and evidence. In our work exploring the complexity of ensuring that practice is informed by evidence we have found that general managers have relatively little influence when compared with clinicians especially doctors. We argue that local professional groups work together in communities of practice, which are frequently uniprofessional. These boundaries affect the motivations for seeking improvement and upgrading and the way evidence and knowledge is perceived and interpreted. We argue that if the quality of health care is to be improved, we need to understand the complex historically and contextually informed interactions between different professional groups and to design diffusion strategies that acknowledge this complexity.

Knowledge to Action? The Implications for Policy and Practice of Research on Innovation Processes

The focus of this chapter is to explore the policy and practice implications arising from research into the diffusion of innovations into use in health care. The empirical data upon which the discussion is founded thus focuses on the latter stages of the innovation process. Here, the practitioners in health care, many of whom are highly qualified clinical professionals, decide whether to accept evidence of an efficacious new intervention, whether drug, technology or service delivery process, and adopt it in their practice.

The political economy of management knowledge: Management texts in English healthcare organizations [accepted manuscript]

Have generic management texts and associated knowledges now extensively diffused into public services organizations? If so, why? Our empirical study of English healthcare organizations detects an extensive presence of such texts. We argue that their ready diffusion relates to two macro-level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed business school/management consulting knowledge nexus. This macro perspective theoretically complements existing explanations from the meso or middle level of analysis which examine diffusion processes within the public services field, and also more micro literature which focuses on agency from individual knowledge leaders.