Tuesday, 21 February 2012

Influence, trust and relationships – the practice of knowledge exchange?

This is the first of what will be a regular post from our Knowledge Exchange reading group. We hope that others find it interesting.

Influence, trust and relationships – the practice of knowledge exchange?
  • Opinion leaders: who are they and how do we find them?

  • Challenging, affirmative or influential: what makes us decide evidence is relevant and how do we react?

  • Knowledgeable assumptions: how do our experiences and instincts limit our need to ask ‘why’?

These are a few questions that members of the CRFR Knowledge Exchange Reading Group were asking after reading ‘Primary Care: Evidence based guidelines or collectively constructed “mindlines”? An ethnography study of knowledge management in primary care’ (Gabby & Le May, 2004). Reading this paper provided an opportunity to reflect on insights into how evidence is used in practice (in two GP surgeries) in day-to-day decision-making.

The authors coined the phrase ‘mindlines’ as a way of describing how practitioners draw on different sources of information to inform what they believe to be clinically good practice. As readers, we assume the practitioners use evidence-based-practice as a result of their formal training and professional registration. However, constantly developing mindlines are formed by a wider range of additional (in some cases stronger?) influences. These wider influences were: their work environment; patients; experience; infrastructure; teachers/training; reading/updates; “they say..”; ‘reps’; opinion leaders; each other and ‘patients views’.

Gabbay J. and May A., BMJ Volume 329, 2004

For these practitioners, guidelines for evidence based clinical practice were readily accessible in a range of formats. However, in practice the guidelines were only one element of this wider mix of influences. Trusted sources of information, which provided commentary, reflections or interpretation of the research literature, appeared to have a greater influence over day to day practice. The evidence base that was being drawn on by these trusted sources themselves was not routinely questioned - that the fact they were trusted was enough.

So, thinking about the questions above, maybe we should take them one step further and also ask:

  • Is it possible to identify (and understand) the different influences for practitioners when they are working within their own dynamic, local context?

  • How do ‘trusted’ sources influence practitioners and (how?) does this compare with the influence of ‘leaders’ (including opinion leaders)?

  • How can we use the ideas of mindlines to inform ways we encourage practitioners to engage with research?

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