Epistemology, evidence and experience: evidence based health care in the work of Accident Alliances

Abstract

Evidence based health care has attracted considerable interest from NHS commissioners, public health specialists and sociologists as both a rational approach to decision making and as representing an ideological shift in health care. This paper explores the social construction of`evidence' in one arena, that of the work of Accident Alliances. Interviews with key participants and observations of meetings suggest a high level of consensus that evidence was important for their work in terms of strategic decision making, operational planning and evaluation. However, evidence was framed differently across the professions and organisations involved in the alliances. Rather than being a neutral tool used to inform decision making, evidence was both constructed through professional practice and contributed to the construction of professional identity. The formal advocacy of evidence based interventions makes explicit a number of potential conflicts in inter-agency working, and Accident Alliances provide an illuminating case study of how these are managed in day-to-day working in health care.

Rhetoric, Evidence and Policymaking: a Case Study of Priority Setting in Primary Care*

“…As the authors comment: "Depending on the group dynamics, interventions using such skills could result in a radical shift in the way in which the group made sense of new information, and incorporated it into their thinking, or could lead to a 'stand-off' in which the new information was simply ignored". Judith Green's exploration of local decision-making by multi-professional Accident Alliances came to similar conclusions about the critical role of individuals in the construction and utilisation of evidence by policymaking groups (Green, 2000). She found that the personalised, practical knowledge of key people was frequently more significant than citations of published research evidence about 'what works'.…”

“…It acknowledges that there is no principled way of making priority decisions (Holm, 1998) and that evidence cannot 'speak for itself' (Green, 2000). (Klein, 1993) And so this phase of the priority setting debate is characterised by policymakers seeking to strengthen the institutional processes of decisionmaking, and involving not only experts and professionals in decision-making but also the public.…”

Avoiding philosophy as a trump-card in sociological writing. A study from the discourse of evidence-based healthcare

“…Stephen Harrison's (1998) political-economic analysis, and Judith Green's (2000) article on 'epistemology, evidence and experience'. Harrison's (1998) view was that while EBHC made sense politically as a vehicle to engage doctors in the rationing of healthcare, it did not make sense philosophically.…”

“…himself in dissent against EBHC, because of its theoretical unsophistication. Green (2000) began her analysis of EBHC with the conceptual construction of Evidence as a route to clinical decision-making. She found that different disciplines and practices generate different evidential cultures which, being constructed in mutual distinction, are incompatible.…”

Perspectives on the ‘lens of risk’ interview series: Interviews with Judith Green and Peter Taylor-Gooby

“…Some of the work I did on looking at how, for instance, evidence was used in what were then called Accident Alliances, multi-sector organisations that were about having a more rational approach to injury prevention (Green, 2000). And it struck me that whenever anyone wanted to make a claim for an evidence-based approach, it never worked in discussion, unless they could tie that to a very emotional appeal.…”