Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care
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Objective To explore in depth how primary care clinicians (general practitioners and practice nurses) derive their individual and collective healthcare decisions. Design Ethnographic study using standard methods (non-participant observation, semistructured interviews, and documentary review) over two years to collect data, which were analysed thematically. Setting Two general practices, one in the south of England and the other in the north of England. Participants Nine doctors, three nurses, one phlebotomist, and associated medical staff in one practice provided the initial data; the emerging model was checked for transferability with general practitioners in the second practice. Results Clinicians rarely accessed and used explicit evidence from research or other sources directly, but relied on “mindlines”—collectively reinforced, internalised, tacit guidelines. These were informed by brief reading but mainly by their own and their colleagues' experience, their interactions with each other and with opinion leaders, patients, and pharmaceutical representatives, and other sources of largely tacit knowledge. Mediated by organisational demands and constraints, mindlines were iteratively negotiated with a variety of key actors, often through a range of informal interactions in fluid “communities of practice,” resulting in socially constructed “knowledge in practice.” Conclusions These findings highlight the potential advantage of exploiting existing formal and informal networking as a key to conveying evidence to clinicians.
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Groups or teams of individuals have an important role in determining the uptake of new knowledge in practice.
“there is good evidence to suggest that groups or teams of individuals have an important role in determining the uptake of new knowledge in practice.”
From PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice (2015) · cites this paper as [39]
Findings from this study and evidence from others' research and conceptualisations show the crucial role that individuals play in the relative success of evidence-based change.
“Findings from this study and evidence from others' research and conceptualisations of evidence-based change and theory show the crucial role that individuals plays in the relative success of evidence-based change [6,7,27,37-39].”
From The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework (2013) · cites this paper as [38]
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- Authors
- Gabbay, J., & May, A. L.
- Affiliations
- University of Southampton (GB)
- Corresponding author
- Gabbay, John
- ORCID
- May, Andrée le
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2004-10-28
- Volume
- 329
- Issue
- 7473
- Pages
- 1013
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC524553
- OpenAlex
- W2083367548
- Cited by
- 986
- References
- 34
- Citations by year
- 2026: 27 · 2025: 31 · 2024: 48 · 2023: 49 · 2022: 36 · 2021: 37 · 2020: 76 · 2019: 52 · 2018: 62 · 2017: 48 · 2016: 49 · 2015: 57 · 2014: 55 · 2013: 35 · 2012: 52
- FWCI
- 74.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- tacit knowledge, knowledge management, primary care, general practitioners, practice nurses, clinical decision-making, communities of practice, evidence-based practice, knowledge transfer, informal networking, pharmaceutical sales representatives, opinion leaders, organizational constraints
- MeSH terms
- England, Family Practice, Humans, Health Knowledge, Attitudes, Practice, Nurse Practitioners, Professional Practice, Practice Guidelines as Topic, Evidence-Based Medicine
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