Introduction

Presumably, one of the main reasons we have research, evidence and information is so that, at some point down the line, improvements can be made to the delivery of public services, however these improvements are defined. If this is the case, clearly it is important to analyse how the products and outputs of research institutions affect actual behaviour in front-line organisations. This chapter, and indeed much of this volume, is taken up with analysing this relationship. The themes discussed here – for example, the role of knowledge dissemination and the impact of organisational forms on behaviour – are not especially new. Unfortunately, as the most cursory of investigations into the current state of affairs will testify, they remain stubbornly relevant. The distinctiveness of this chapter (as opposed to the others in this book) is in its focus on two aspects of this broader debate: organisations and knowledge management.

As we have seen in previous chapters, there is a growing realisation that simply generating more evidence is not enough to overcome the gaps between research, policy and practice. Indeed, the establishment of the Cochrane Collaboration's Effective Practice and Organisation of Care Group is a direct response to the lack of impact of such passive models of evidence dissemination (www.epoc.cochrane.org). The changes required in shifting from practices based on habit and custom to ones informed by evidence of best practice can be understood as processes of innovation and improvement. The ‘evidence-based movement’ in public services can thus be interpreted, at least in part, as a call for innovation in the way health and social care services are organised and delivered. Within health and social care, innovation might take a variety of forms, including new products, devices and procedures as well as new ways of organising, delivering and/or governing services. That said, innovation and improvement should properly be understood as processes rather than single events or interventions and, although such processes are rarely linear, it is helpful to think of them as involving four stages of change: discovery, adoption, diffusion and routinisation.

The shift of focus from passive ‘dissemination’ to active innovation and improvement reflects awareness of the need for more nuanced understandings of how context – notably at organisational level – can influence the extent to which prescriptions for best practice are adopted.