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Health services can and should be improved by applying research findings about best practice. Yet, in The Myth of Rationality, the authors explore why it nevertheless proves notoriously difficult to implement research evidence in the face of strong professional views and complex organizational structures. Drawing on a large body of evidence acquired in the course of nearly fifty in-depth case studies following attempts to introduce evidence-based practice in the UK NHS over more than a decade. Using qualitative methods to study hospital and primary care settings, they are able to shed light on why some of these attempts succeeded where others faltered. By opening up the intricacies and complexities of change in the NHS, they reveal the limitations of the simplistic approaches to implementing research or introducing evidence-based health care. A unique synthesis of evidence, the book brings together data from 1,400 interviews with doctors, nurses, and managers, as well as detailed observations and documentary analysis. The authors provide an analysis, rooted in a range of theoretical perspectives, that underlines the intimate links between organizational structures and cultures and the utilization of knowledge, and draws conclusions which will be of significance for other areas of public management. Their findings have implications for the utilization of knowledge in situations where there is a professional tradition working within a politically sensitive blend of public service, managerial accountability, and technical expertise. A unique synthesis of evidence, the book brings together data from 1,400 interviews with doctors, nurses, and managers, as well as detailed observations and documentary analysis. The authors provide an analysis, rooted in a range of theoretical perspectives, that underlines the intimate links between organizational structures and cultures and the utilization of knowledge, and draws conclusions which will be of significance for other areas of public management. Their findings have implications for the utilization of knowledge in situations where there is a professional tradition working within a politically sensitive blend of public service, managerial accountability, and technical expertise.

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