Using evidence in health and healthcare

Abstract

While for many fields of practice ‘what works’ thinking was a relatively new phenomenon back in 2000, the field of health and healthcare could already look back on over a quarter of a century of debate about the challenges of using evidence in service delivery and improvement (Davies and Nutley, 2000). Systematic study in healthcare had found large and unjustified variations in clinical practice (Wennberg et al, 2016), significant levels of inappropriate care (Brook, 1994) and evidence of over-medicalisation and treatment-induced ill health (Illich, 1974). Questions were being asked about both the effectiveness and the cost-effectiveness of care (Cochrane, 1972). The development of Evidence Based Medicine (EBM) was one major response to these concerns, a development that has an interesting and well-documented history (summarised in Box 4.1). This chapter considers the on-going development and influence of this dominant discourse relating to evidence use. It discusses: the evolution of EBM; the importance of the nature and quality of evidence within EBM; the structures and systems that have emerged for the production and synthesis of research; and the development of key approaches to encouraging and enabling evidence use in medicine specifically and in healthcare more broadly. While evidence in healthcare has come to mean so much more than just clinical evidence, EBM remains the normative model against which other applications of evidence are so often compared. The EBM approach and the evidence-based movement associated with it can be regarded as a disruptive technology – a new way of doing things that sought to overturn previous practices.