Evidence-based practice in Steeltown: a good start on needed cultural change.

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At the Canadian Health Services Research Foundation we talk a lot about the need to improve the 'receptor capacity' for research in the health sector (Canadian Health Services Research Foundation 2000). To create a demand for research as well as a supply of it. To encourage and assist clinicians, managers and policymakers in the health system to pull research from academe with as much fervor as applied researchers now bring to publishing it. Browman, Snider and Ellis have done more than talk about and encourage these things - they have implemented them at their own workplace in Hamilton. Their formula is:1. Design a policy-learning forum (Clinical Policy Committee'), where the use of available research is encouraged and expected 2. Create champions (knowledge stewards') responsible for marshalling and presenting the evidence. 3. Provide rules (negotiation') for the dialogue between the operational implications of the research and its budgetary reality. 4. Use story telling to uncover local implementation barriers and make tacit knowledge explicit. The approach is reminiscent of political scientist Paul Sabatier's description of the circumstances under which policy learning occurs (Sabatier and Jenkins-Smith 1993) and Brown and Duguid's compelling outline of how information permeates corporate structures (Brown and Duguid 2000). Sabatiers advocacy coalition framework highlights the optimal conditions for learning as: balanced coalitions (in this case, of those behind the research and those behind the finances), enough resources for each side to produce a steady flow of information, an organized forum for debate and clear rules of engagement. In 'The Social Life of Information, 'Brown and Duguid highlight the extent to which modern corporations often leave unrecognized and under-utilized their greatest asset - the tacit knowledge accumulated by each employee over his or her career. They, too, recommend storytelling as a way to liberate this knowledge for wider use. Browman and colleagues 'practical realization of Sabatier' advocacy coalition framework and Browns social view of information is refreshing on a number of levels.