ABSTRACT

A policy aspiration is that evidence should inform decision-making on introducing health service innovations. Internationally, innovation adoption has historically been slow and patchy. Three innovations in the English and Scottish National Health Service were analysed qualitatively: stroke service reconfiguration; revised national guidance on cancer referral; and ‘virtual’ glaucoma outpatient clinics. The authors identify three sociomaterial mechanisms through which evidence and context shape each other in decision-making: connecting, ordering, resisting. Shared preferences for research evidence enabled the medical profession to exert influence on decision-making, while other professions used alternative evidence. Implications for promoting inclusive public management around service innovations are discussed.

摘要

一个政策愿望是证据应该为引入卫生服​​务创新的决策提供信息。在国际上，创新的采用历来缓慢且参差不齐。定性分析了英国和苏格兰国民健康服务的三项创新：卒中服务重新配置；修订了关于癌症转诊的国家指南；和“虚拟”青光眼门诊。作者确定了三种社会物质机制，证据和背景通过这些机制在决策制定中相互影响：联系、排序、抵制。对研究证据的共同偏好使医学专业能够对决策产生影响，而其他专业则使用替代证据。讨论了围绕服务创新促进包容性公共管理的意义。