From Research Evidence to “Evidence by Proxy”? Organizational Enactment of Evidence‐Based Health Care in Four High‐Income Countries

Abstract

Drawing on multiple qualitative case studies of evidence-based health care conducted in Sweden, Canada, Australia, and the United Kingdom, the authors systematically explore the composition, circulation, and role of codified knowledge deployed in the organizational enactment of evidence-based practice. The article describes the "chain of codified knowledge," which reflects the institutionalization of evidence-based practice as organizational business as usual, and shows that it is dominated by performance standards, policies and procedures, and locally collected (improvement and audit) data. These interconnected forms of "evidence by proxy," which are informed by research partly or indirectly, enable simplification, selective reinforcement, and contextualization of scientific knowledge. The analysis reveals the dual effects of this codification dynamic on evidence-based practice and highlights the influence of macro-level ideological, historical, and technological factors on the composition and circulation of codified knowledge in the organizational enactment of evidence-based health care in different countries. Evidence for Practice• The evidence-based policy and practice movement encourages the incorporation of evidence from research into decision making. • Its implementation at the organizational level involves an increasing role for "evidence by proxy," such as performance standards, organizational policies, and local data. • Different forms of evidence by proxy are interconnected, simplifying scientific knowledge, reinforcing some of its elements, and making it applicable to the local context. • Frontline practitioners tend to rely on evidence by proxy, which is created, circulated, and analyzed by specialists. • The composition and circulation of different forms of evidence by proxy differ across countries.

Staging Science: Authoritativeness and Fragility of Models and Measurement in the COVID‐19 Crisis

“…Playing this central role is far from evident for scientists. The institutionalization of knowledge use in decision‐making practice is slow (Kislov et al ) and context dependent (Jennings and Hall ). Authoritative science takes time.…”

Constructing a problem and marketing solutions: A critical content analysis of the nature and function of industry‐authored oral health educational materials

“…With the shift from a welfare state to neoliberalism and implementation of new public management within hospitals, prelicensure nursing education shifted from a theoretically grounded to competency-based education, characterised as measurable, technical and amenable to interventions promoting efficiency and effectiveness (Foth & Holmes, 2017). Within practice settings, evidence-based practice is implemented and enforced through managerial practices including standardisation and performance evaluation with a resulting focus on surveillance, documentation and risk management (Kislov et al, 2019). Kislov et al (2019) term "evidence by proxy" to inform clinical decision-making.…”

“…Within practice settings, evidence-based practice is implemented and enforced through managerial practices including standardisation and performance evaluation with a resulting focus on surveillance, documentation and risk management (Kislov et al, 2019). Kislov et al (2019) term "evidence by proxy" to inform clinical decision-making. Taking the form of evidence-based practice guidelines or organisational policies and procedures, "evidence by proxy" is created and disseminated by experts external to the practice setting, who curate and synthesise research evidence and translate it into messaging designed for uptake by specific audiences such as staff nurses in specific contexts (Kislov et al, 2019).…”

“…However, because evidence is translated and codified, "evidence by proxy" tends to elide nuances related to the certainty of recommendations, the strength of underlying evidence and risks of bias (Kislov et al, 2019).…”

Bowling Alone, Rigor, and the Decline of Social Capital in Academic Service

“…With the potential of big data increasingly being recognized by policy makers at all levels, their article provides valuable insight into the development and use of such systems to improve performance. Kislov et al () provide a comparative analysis of health care in four high‐income countries to better understand the effect of requirements to utilize evidence‐based practice in different contexts. They highlight the importance and growing concern associated with practitioners' use of “evidence by proxy,” which amounts to codified knowledge that is only indirectly or tangentially related to actual scientific evidence.…”