The Social Organization of Best Practice: An Institutional Ethnography of Physicians Work [Paperback]

This book explores how best practice for acute stroke care was developed, translated and taken up in medical practice across various sites in the province of Ontario using institutional ethnographic research. Institutional ethnography, an approach developed by Dorothy E. Smith, builds on Smiths understanding of the social organization of knowledge, allowing for an examination of the complex social relations organizing peoples experiences of their everyday working lives.

This work thereby makes visible some of the assumptions and hidden priorities underlying the emphasis given to translating scientific knowledge into medical practice. In this study, the discourses of both evidence-based medicine and knowledge translation, purportedly designed to improve patient care, come into view as managerial tools that directed healthcare resources toward academic hospitals rather than community sites where the majority of patients receive care. These models institutionalize inequities in access to care while claiming to resolve them.

Chapter 1: Introduction.- Chapter 2: Developing the Ethnographic Study.- Chapter 3: Setting the Stage for Implementing Evidence: the OSS.- Chapter 4: The Everyday Practices of RCTs.- Chapter 5: Variations in the Implementation of Evidence.-Chapter 6: Evaluating the OSS.- Chapter 7: Conclusion.

Fiona Webster is Associate Professor in the Arthur Labatt Family School of Nursing at Western University in London, Ontario, Canada. Webster obtained her PhD in sociology under the supervision of Dorothy E. Smith at the University of Toronto, Canada.

This book offers a unique critique of evidence based-medicine and how it plays out in everyday practice. It engages with and problematizes the scholarship around best practice in an informed and perceptive manner and in doing so, advanls3