Practice-based Evidence for Healthcare
Routledge – 2011 – 276 pages
This book challenges the evidence-based practice movement to re-think its assumptions. Firmly rooted in real practice while drawing lucidly on a great breadth of theoretical frameworks, it examines afresh how clinicians use knowledge.
Evidence-based practice has recently become a key part of the training of all health professionals. Yet despite its ‘gold-standard’ status, it is faltering because too much effort has gone into insisting on an idealised model of how clinicians ought to use the best evidence, while not enough has been done to understand why they so often don’t.
Practice-based Evidence for Healthcare is a groundbreaking attempt to redress that imbalance. Examining how clinicians actually develop and use clinical knowledge day-to-day, the authors conclude that they use ‘mindlines’– internalised, collectively reinforced, tacit guidelines. Mindlines embody the composite and flexible knowledge that clinicians need in practice. They are built up during training and continually updated from a wide range of formal and informal sources. Before new evidence becomes part of practitioners’ mindlines, it is transformed by their interactions with colleagues and patients via their communities of practice and networks of trusted colleagues.
To explore how mindlines work Gabbay and le May draw on a wide range of disciplines to analyse their detailed observations of clinical practice in the UK and the US. Their conclusions and provocative recommendations will be of value to all practitioners, health service managers, policymakers, researchers, educators and students involved in the promotion of evidence-based practice.
'This book is one of the most important publications about clinical practice in general and evidence based medicine in particular to appear in the last 20 years. Those who consider themselves to be working at the ‘cutting edge’ in these fields should make time to read it.' - Trisha Greenhalgh, University College London, UK
'This amazing book, which will revolutionize the way we think about clinical practice as well as the way we teach practitioners, should push the whole field forward by a quantum leap. Practice-based Evidence will come as a big relief to thinking practitioners who have felt oppressed by the evidence-based practice movement, and should be on the 'must read' list for anyone involved with meeting continuing competency requirements in both nursing and medicine.' - Lesley Degner, University of Manitoba, Canada
'This is a fascinating analysis that rings true with my own clinical experience. It will doubtless be eagerly devoured by those who study clinical decision-making but anyone concerned with clinical practice and policy, however busy, will gain by reading it. This valuable book addresses issues that are of crucial importance and from which we all need to learn.' - Joel Howell, University of Michigan, USA
'The actors who speak at the beginning of each chapter remind me of people I have met and worked with all through my career; they describe my behaviours at various stages of my life as a clinician. So, I felt very comfortable reading this book, which is filled with wisdom distilled from many disciplines and raises major issues about professional development. It will have a significant and lasting impact on how I view a number of concepts. Very few books have such a powerful influence.' - John Balla, Centre for Evidence Based Medicine, University of Oxford, UK and University of Melbourne, Australia
'This important book makes a major contribution to our understanding about the everyday problems of making sense of clinical knowledge in practice. Grounded in real world research that gives a unique insight into the real world of health professionals, John Gabbay and Andrée le May will not only inform the implementation of evidence-based practice, but also help to shape future studies of this key problem of contemporary health care, which has never been more politically contentious' - Carl May, Newcastle University, UK
1. Introduction: evidence in practice; 2. From formal knowledge guided complexity; 3.Clinical thinking and knowledge in practice; 4. Growing mindlines: laying the foundations; 5. Growing mindlines: cultivating contextual adroitness; 6. The place of storytelling in knowledge sharing; 7. A community of clinical practice?; 8. Co-constructing collective mindlines; 9. Co-constructing clinical reality; 10; Conclusions and implications
John Gabbay is Emeritus Professor at the Wessex Institute for Health Research and Development, University of Southampton, UK.
Andrée le May is Professor of Nursing at the University of Southampton, UK.