COR faculty workshop:
Miriam Bender (Program in Nursing Science)
Friday, February 5, 12:00-1:30pm in SBSG 1321.
Lunch will be provided.
“Using Callon’s Framing/Overflow Concepts to Understand Current Debates on Evidence-based Practice”
Martha Feldman (Social Ecology) and Gerardo Okhuysen (Merage) will serve as discussants.
Please see the paper abstract below. When you RSVP, we will send you the paper copy to read in advance of the workshop. Please RSVP by February 1.
Abstract: Evidence based practice (EBP) as an approach to health care decision-making emerged from an initiative first articulated by physicians in the 1970s. EBP developed as a reaction to documented heterogeneity of healthcare practices, which made it impossible to know which practices actually produced beneficial outcomes. Proponents of EBP believe scientific evidence generation is the best way to identify and measure the effectiveness of healthcare treatments and thereby build a solid knowledge base with which to deliver optimal healthcare. EBP is most popularly defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (Sackett et al, 1996). Evidence here is explicitly defined as findings from well-designed research studies. The EBP movement, or what some call an ideology, has been widely accepted by diverse healthcare disciplines. The Institute of Medicine has in fact challenged the United States to ensure 90% of all clinical decisions are evidence informed by 2020. This is proving quite problematic. Some relate the difficulties to the challenges of implementing evidence into practice, which involves additional elements such as context, patient preference and clinical expertise, and which are becoming an increasing focus of scientific examination. Others believe the assumptions inherent in EBP are themselves at issue. The debate continues with no apparent resolution and no significant progress towards the ultimate goal of improving health outcomes. Michel Callon, a sociologist, advanced the concepts of framing/overflow, which can help understand this state of affairs. In this article I explore current views of EBP and the achievements made possible by framing healthcare as EBP. I also explore what EBP framing does not acknowledge and therefore cannot achieve. This involves an examination of the overflows inherent in healthcare, and EBP, relating back to both identified EBP implementation challenges and current criticisms of EBP assumptions. I end with a discussion of what can be gained by considering the duality of framing and overflow in relation to healthcare delivery, and how this nonlinear approach might facilitate better care delivery as well as better health.