Actionable tools in healthcare: an ethnography of the relationship between research, knowledge brokering and end use of research derived outputs

Large numbers of ’tools’ are produced as outputs of funded health research, though with mixed evidence of their effectiveness or suitability for practice. There is an expectation that research evidence will be adopted in the NHS to maximise efficiency, improve health benefits or services. However, this assumption fails to understand the contextual realities of implementing new interventions in the NHS, and hence an appreciation of what works, for whom and in what context (Tilley and Pawson 1997). Graham et al’s (2006) conceptualisation of ’knowledge to action’ combines two components, knowledge production and the action cycle. This idea includes a set of principles guiding action, with knowledge being increasingly shaped to meet the needs of stakeholders. The knowledge to action cycle rarely proceeds smoothly, and may sometimes require the involvement of knowledge brokers to connect the world of research production with the end-point, to facilitate adoption of knowledge in a specific context. One way this might be attempted is through a consideration of how ’Knowledge brokers’ engage in ‘boundary’ work with other agencies to capture the social processes influencing the implementation of knowledge in healthcare settings. All of this suggests that actionable tools do not self-evidently become adopted and require powerful engagement at all levels of the knowledge-to-action cycle. The PhD study will examine these relationships focusing on researchers, knowledge brokers, and end users, to identify the mechanisms affecting the integration of actionable tools in context.
The study will address two questions with ethnographic methods: a) how actionable tools are used by healthcare professionals (what works for whom and in what context), b) are knowledge brokers used in the process, and if so who are they and what role do they play? One actionable tool will be chosen to explore tool-use in at least two clinical settings. The study will investigate variation (if any) in attitudes and behaviours towards tool use in the different settings, employ observations of peer to peer interactions and examine the drivers of tool use (or otherwise). Interviews/focus groups will also be deployed to examine perceptions towards actionable tools by healthcare professionals and other stakeholders such as commissioners, where appropriate. A theoretical framework will guide theory generation and interpretation of the findings.
Dr Sanders is a medical sociologist whose work focuses on clinical communication and knowledge mobilisation / implementation of health-related research. Professor Cooke is a health services researcher and Chief Investigator of a recent Delphi study of the definition and added value of Actionable Tools in healthcare, funded by NHS England.