10 years of mindlines: a systematic review and commentary
Open accessAbstract
BACKGROUND: In 2004, Gabbay and le May showed that clinicians generally base their decisions on mindlines-internalised and collectively reinforced tacit guidelines-rather than consulting written clinical guidelines. We considered how the concept of mindlines has been taken forward since. METHODS: We searched databases from 2004 to 2014 for the term 'mindline(s)' and tracked all sources citing Gabbay and le May's 2004 article. We read and re-read papers to gain familiarity and developed an interpretive analysis and taxonomy by drawing on the principles of meta-narrative systematic review. RESULTS: In our synthesis of 340 papers, distinguished between authors who used mindlines purely in name ('nominal' view) sometimes dismissing them as a harmful phenomenon, and authors who appeared to have understood the term's philosophical foundations. The latter took an 'in-practice' view (studying how mindlines emerge and spread in real-world settings), a 'theoretical and philosophical' view (extending theory) or a 'solution focused' view (exploring how to promote and support mindline development). We found that it is not just clinicians who develop mindlines: so do patients, in face-to-face and (potentially) online communities. Theoretical publications on mindlines have continued to challenge the rationalist assumptions of evidence-based medicine (EBM). Conventional EBM assumes a single, knowable reality and seeks to strip away context to generate universal predictive rules. In contrast, mindlines are predicated on a more fluid, embodied and intersubjective view of knowledge; they accommodate context and acknowledge multiple realities. When considering how knowledge spreads, the concept of mindlines requires us to go beyond the constraining notions of 'dissemination' and 'translation' to study tacit knowledge and the interactive human processes by which such knowledge is created, enacted and shared. Solution-focused publications described mindline-promoting initiatives such as relationship-building, collaborative learning and thought leadership. CONCLUSIONS: The concept of mindlines challenges the naïve rationalist view of knowledge implicit in some EBM publications, but the term appears to have been misunderstood (and prematurely dismissed) by some authors. By further studying mindlines empirically and theoretically, there is potential to expand EBM's conceptual toolkit to produce richer forms of 'evidence-based' knowledge. We outline a suggested research agenda for achieving this goal.
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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 [40]
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- Authors
- Wieringa, S., & Greenhalgh, T.
- Affiliations
- Queen Mary University of London (GB)
- University of Oxford (GB)
- Corresponding author
- Wieringa, Sietse
- Venue
- Implementation Science
- Published
- 2015-04-09
- Volume
- 10
- Issue
- 1
- Pages
- 45-45
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC4399748
- OpenAlex
- W2143333618
- Cited by
- 150
- References
- 103
- Citations by year
- 2026: 7 · 2025: 19 · 2024: 16 · 2023: 16 · 2022: 7 · 2021: 9 · 2020: 21 · 2019: 18 · 2018: 13 · 2017: 13 · 2016: 6 · 2015: 5
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Implementation Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (IPF-12-16, NF-SI-0512-10031)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- tacit knowledge, clinical decision-making, clinical guidelines, critique of evidence-based medicine, knowledge dissemination, knowledge translation, embodied knowledge, intersubjectivity, patient knowledge, cooperative learning, thought leadership, research agenda
- MeSH terms
- Decision Making, Humans, Practice Patterns, Physicians', Physicians, Guideline Adherence
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