Applying Research to Health Care Policy and Practice: Medical and Managerial Views on Effectiveness and the Role of Research

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Abstract
Objectives: This study explores the way in which doctors and managers think about the effectiveness of health care interventions and how this shapes the evidence they use to support decision-making. Methods: Case studies of the introduction of three new medical technologies in nine National Health Service (NHS) hospitals and health authorities. Results: Effectiveness research provides essential evidence on clinical and cost-effectiveness and is used primarily by clinicians and public health doctors for this purpose. However, research fails to provide the ‘evidence’ required by managerial decision-makers, whose objectives relate as much to the effect of a technology on organisational performance as on patient health and well-being. The evidence used to inform technology adoption decisions reflects the professional role and objectives of different decision-makers. Conclusions: The assumed relationship between ‘research’ and ‘evidence’ for the purpose of promoting effective health care does not take account of the wide range of objectives pursued by different health care decision-makers and the varied sources of ‘evidence’ they use to support their decisions.