| Description |
1 online resource |
| Contents |
Intro -- Foreword -- Acknowledgements -- Contents -- Acronyms and Abbreviations -- Chapter 1: Introduction -- References -- Chapter 2: Developing the Ethnographic Study -- Institutional Ethnography -- The Study -- The Problematic -- Data Collection Techniques -- The Data -- Institutional Capture -- References -- Chapter 3: Setting the Stage for Implementing Knowledge: The Ontario Stroke Strategy -- The Ideal of the Ontario Stroke Strategy -- District Stroke Centres -- Problems in the Continuum of Care -- Betty's Story3 -- References |
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Chapter 4: The Everyday Practices of Randomized Controlled Trials -- The Clinical Trial in Situated Practice -- Debating the Evidence -- References -- Chapter 5: Variations in the Implementation of Best Practice: From Academic Hospital to Community Settings -- Observations -- Identification of Stroke -- Problems in Clinical Diagnosis -- On Call Issues -- Problems with Technology -- Patient Preferences -- References -- Chapter 6: A Virtual Success: Evaluation of the Ontario Stroke Strategy -- Debates About Who Should Provide rt-PA -- The Patient's Body as a Site for Conducting Research |
| Summary |
'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, advances the field in a critical way. -- Grainne Kearney, Clinical Lecturer in the School of Medicine, Dentistry, and Biomedical Sciences, Queens University Belfast, Ireland 'Websters institutional ethnographic research describes how standardizing approaches actually play out in practice. In rich, thick detail we are shown the institutional processes that organize how objective clinical evidence is "rolled out" into the context-laden, deeply social world of healthcare. Offering a unique counter-narrative, the book is illustrative of gaps and risks that may arise when local knowledge is subordinated to coordinated directives from afar. -- Janet Rankin, Associate Professor of Nursing, University of Calgary, Canada 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 cl aiming to resolve them |
| Bibliography |
Includes bibliographical references and index |
| Notes |
Online resource; title from PDF title page (EBSCO, viewed July 10, 2020) |
| Subject |
Social medicine.
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Evidence-based medicine.
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Social medicine -- Ontario -- Case studies
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Evidence-based medicine -- Ontario -- Case studies
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Ethnosociology.
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Ethnosociology
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Evidence-based medicine
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Social medicine
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Ontario
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| Genre/Form |
Case studies
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Case studies.
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Études de cas.
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| Form |
Electronic book
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| ISBN |
9783030431655 |
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3030431657 |
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