InUsing Knowledge and Evidence in Health Care: Multidisciplinary Perspectiveswe present a wide-ranging discussion of one of the most influential developments in contemporary health care research, policy-making, and delivery. Evidence-based decision-making (EBDM) in health care and, in particular, the term ‘evidence-based medicine’ and its concepts originated in the early 1990s with the work of clinical epidemiologists at McMaster University in Hamilton, Ontario (Evidence-Based Medicine Working Group, 1992). In their discussions, however, there was often little acknowledgment that studies of the uptake of research-based information had also been of interest to many other disciplines for a much longer period of...

Many analysts of contemporary western societies claim we have moved from an industrial economy to a knowledge-based economy. Knowledge is increasingly seen as an important asset in organizational and social development (Blackler, 1995; Brown & Duguid, 1991; David & Foray, 2002; Empson, 2001; Nahapiet & Ghoshal, 1998). Hence, in a knowledge-based economy or society, knowledge should be produced, disseminated, and applied with greater intensity and at a faster pace than in previous eras. In a knowledge-based economy or society the utilization of knowledge is routinized and institutionalized. One may thus infer that major changes in the production, dissemination, and application...

Modernity encompasses the rationalist dream that science can, and will, produce the knowledge required to emancipate us individually and collectively from scarcity, ignorance, and errors. The lucidity of this dream, however, has waxed and waned over time. Currently, in the context of the knowledge society, we are being enticed, cajoled, and otherwise encouraged to increase and improve the transfer and utilization of research knowledge. The call for evidence-based health care is one expression of the dream.

Appeals for evidence-based health care began with the idea of evidence-based medicine. Evidence-based medicine is founded on the preference for clinical decisions that are...

A political science perspective on evidence-based decision-making can be summarized quite simply: evidence-based decision-making rarely exists in a modern democracy (an empirically grounded observation), and it probably should not exist in a modern democracy (a normative statement). Who wins and who loses matter. Consider a hypothetical scenario in which research evidence indicates that if a government transfers income from the least well-off citizens to the most well-off citizens, the average level of health in society will increase. The majority of citizens would probably not wish to see this evidence acted upon. Evidence-informed decision-making is another issue entirely: evidenceinformed decision-making does...

The study of the use of information, knowledge, and evidence in decision-making has long been an important part of organizational theory. Organizational scholars have focused on studies of decision-making generally and strategic planning more specifically, because decision-making defines both the work and the outcomes of organizations (e.g., see Mintzberg, 1973; Stewart, 1967, 1975). Decisions shape the services and products of organizations, the experiences of those who work in them, and the satisfaction and lifestyles of stakeholders and customers of organizations (Miller, Hickson, & Wilson, 1996).

The growing focus on the development and application of evidence-based medicine has stimulated interest in...

The spread of innovations is considered to be an integral part of social and cultural change (Kroeber, 1923; Tarde, 1903; Wissler, 1923). With roots in anthropology and sociology, innovation theory originally was focused on the diffusion, or rate of spread, of an innovation among a discrete population (Rogers, 1995; Ryan & Gross, 1943). Innovation diffusion research within the health care sector began in the 1950s, predominantly in the fields of public health and medical sociology, and has generated hundreds of studies in which the diffusion of health care practices and technologies is described. A 1995 review of diffusion research identified...

‘Making decisions based on scientific evidence is a good thing.’ This simple yet daring hypothesis justifies the current movement that has been named evidence-based decision-making.

The complex nature of health systems has produced large areas of uncertainty pertaining to the relationship between health problems and the interventions that could resolve them. These areas of uncertainty are widening under the pressure of rapid technological development, aging populations, and the public’s ever-increasing expectations. The establishment of major health insurance programs during the decades following the Second World War fuelled, during the 1970s, the need for scientific evidence capable of guiding decision-making that...

Medicine is often thought of as a mixture of art and science. Its ‘scientific’ aspects consist of the wealth of knowledge arising from the biomedical researcher’s laboratory and from the epidemiologist’s desk, which provides empirically generalizable knowledge to health care professionals. Its ‘artistic’ aspects derive from the physician’s experience, in the form of intuitions, rules of thumb, heuristics, and ‘remindings’ of past experiences with particular patients. In some ways, these two aspects are integrated in medical practice to the extent that medicine makes use of both scientific and experiential knowledge (Enkin & Jadad, 1998).

In recent years, however, there has...

In this chapter we discuss the relationship between decision-making, its computerization, and the use of computers to support human decision-making. Our discussion is focused on the relationship between the integration of accurate, updateable, retrievable, and useful computerized information and an understanding of how humans accommodate and process information during decision-making. A decision can be seen not as a single isolated event, but rather as an act that takes place in a continuum of actions, by an individual, in a given organizational context. This crucial aspect of the dynamic unfolding of decisions has been neglected in most work on decision support...

In this chapter the origins, scientific precepts, aspirations, and modus operandi of evidence-based medicine (EBM) are described.¹ The term and current concepts originated from clinical epidemiologists at McMaster University (Evidence-Based Medicine Working Group, 1992). EBM is based on the principle that clinicians, if they are to provide optimal care for their patients, need to know enough about applied research principles to detect studies published in the medical literature that are both scientifically strong and ready for clinical application. This potential for continuing to improve the quality of medical care stems from ongoing public and private investment in biomedical and health...

The tradition of knowledge utilization¹ and related research in the health sciences is among recent efforts to root policy and practice decisions in science. The evidence-based medicine movement (Evidence-Based Medicine Working Group, 1992) emerged in the early 1990s and quickly evolved into more general calls for the adoption of an evidence-based decision-making culture at all levels of the health care system (Gray, 1995; National Forum on Health, 1997). In the Canadian context, these efforts eventually contributed to pressures to downsize the welfare state and increase the efficiency and effectiveness of those components that were not eliminated or privatized. The roots...

Anyone who has typed, which in these days of the computer must be everyone under age forty, has surely wondered about the awkwardness of the keyboard layout. That pesky but frequently needed ‘a’ is forced to rely on the weak left little finger, while ‘f,’ ‘g,’ ‘h,’ and ‘j’ - not needed in more than 70 per cent of English words - seem idiosyncratically placed in prime position. The rational layout for a keyboard would be to place frequently used letters on the home key locations and array the progressively less frequently used letters in the outer reaches.

Stephen Jay...