Evans et al. (2013) [17] Mixed methods; national email To understand the role of According to one senior Tension between resources Government policy, initiatives, survey of health service research evidence at the local manager, preference for required to appraise research to and targets influenced commissioners in Local Health level in relation to the approach to care by inform commissioning commissioning context and ‘informed Boards (n=22) and implementation of a national professional decisions and that required to drove decision making. contacts’ over other interviews (n=5). chronic conditions management forms of evidence. implement changes to services. policy. Evidence-based policy valued but its use in practice constrained by budgetary pressures. Gallego (2008) [7] Qualitative study of To aid the design of a new Some decision-makers lack Decision-makers’ narrow view interviews process of technology knowledge and understanding of of economic evidence - based on perceptions; (n=12) with senior managers, assessment and decision making. economic evaluation; its costs and budgetary constraints – clinical service (medical), credibility and accuracy, influenced potentially by need middle managers, medical especially at a local system level, for rationing in health care clinicians, and nurse managers. questioned. system (budgetary impact and costs main deciding factor). Harden and Fulop (2015) [61] Qualitative study of seven To explore how decision-making use Institutional or management - Committee chairs’ moderate Cancer networks, responsible for can be improved in healthcare of different types of evidence issues in the organisation of care enhancing multi-disciplinary contexts, such as cancer care (leadership) (what the authors steered conversations toward cancer care. Data collected networks, by adopting term the difference between scientific and technical themes at through video-recordings of and the expense of narrative ‘relational’ leadership ‘single ontology’ fifty-three network practices. perspectives, representing sense making). committee meetings. sense-making. ‘single ontology’ Hendy and Barlow (2013) [53] Ethnography; five comparative, To explore how managers' use - Evidence adapted to benefit - Innovation spread mediated by - longitudinal case studies of evidence to inform decisions managers and local staff based its alignment with recipient remote care (telecare) services about innovation adoption. on (e.g. organisation (non-alignment of managers’ agendas using formal interviews (115 alignment with existing practices organisation's values and hours), informal discussions and and needs, moderating expectations and managers'
Evans et al. (2013) [17] Mixed methods; national email survey of health service commissioners in Local Health Boards (n=22) and interviews (n=5). To understand the role of research evidence at the local level in relation to the implementation of a national chronic conditions management policy. According to one senior manager, preference for approach to care ‘informed by professional contacts’ over other forms of evidence. Tension between resources required to appraise research to inform commissioning decisions and that required to implement changes to services. Government policy, initiatives, and targets influenced commissioning context and drove decision making. Evidence-based policy valued but its use in practice constrained by budgetary pressures. Gallego (2008) [7] Qualitative study of perceptions; interviews (n=12) with senior managers, clinical service (medical), middle managers, medical clinicians, and nurse managers. To aid the design of a new process of technology assessment and decision making. Some decision-makers lack knowledge and understanding of economic evaluation; its credibility and accuracy, especially at a local system level, questioned. Decision-makers’ narrow view of economic evidence - based on costs and budgetary constraints – influenced potentially by need for rationing in health care system (budgetary impact and costs main deciding factor). Harden and Fulop (2015) [61] Qualitative study of seven Cancer networks, responsible for enhancing multi-disciplinary cancer care. Data collected through video-recordings of fifty-three network meetings. To explore how decision-making can be improved in healthcare contexts, such as cancer care networks, by adopting ‘relational’ leadership practices. Committee chairs’ moderate use of different types of evidence (leadership) (what the authors term the difference between ‘single ontology’ and sense making). Institutional or management issues in the organisation of care steered conversations toward scientific and technical themes at the expense of narrative perspectives, representing ‘single ontology’ sense-making. - Hendy and Barlow (2013) [53] Ethnography; five comparative, longitudinal case studies of remote care (telecare) services using formal interviews (115 hours), informal discussions and To explore how managers' use evidence to inform decisions about innovation adoption. - Evidence adapted to benefit managers and local staff based on managers’ agendas (e.g. alignment with existing practices and needs, moderating - Innovation spread mediated by its alignment with recipient organisation (non-alignment of organisation's values and expectations and managers' - committee
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