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.

中文翻译：

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英格兰骨科手术中的知识动员：为什么知识层次与专业社会化群体中的证据层次关系不大

背景：医疗政策鼓励在提供医疗服务时使用科学证据。然而，尽管政策制定者不断努力确保它们在实践中的使用，实践的复杂性限制了在临床指南中使用编码知识。本研究采用知识动员的视角来探索科学证据在实践中产生变化的多个层次。目的：探索专业化的临床医生群体如何在高度专业化和组织规范的骨科手术环境中调动知识。方法：使用 2014-15 年的案例研究方法检查了英格兰三个对比鲜明的 NHS 医院。数据包括对外科医生和 NHS 工作人员的 64 次访谈，对日常实践的 9 个月观察，并收集121份补充文件。多层次专题分析和跨案例比较探讨了个体外科医生、专业团体和医院组织如何调动知识。调查结果：调查结果描述了三个主题，以说明骨科实践中的差异是如何出现的：1）专业身份；2）知识获取；3) 实践的情境偶然性。外科医生所认同的专业群体对组织内知识的动员方式具有重大影响。结论：专业社会化外科团体所拥有的知识对于解释在提供医疗保健服务中观察到的变化至关重要。骨科手术实践中的知识层次与作为临床指导和指南产生的基础的证据层次关系不大。在专业外科医生群体中定义和享有特权的知识在实践中具有重要意义，并产生了偶然的知识动员。