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To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9299.2009.01796.x Byline: EWAN FERLIE (1), SUE DOPSON (2), LOUISE FITZGERALD (4), LOUISE LOCOCK (3) Abstract: Health systems internationally have developed policies to support evidence-based health care (EBHC) for over a decade. As this article shows, the time is ripe to review current policy frameworks in an evidence-based manner. We summarize key themes deriving from qualitative research on the UK EBHC implementation and draw out implications for policy renewal. Our diagnosis is different from current UK NHS (National Health Service) policy since we stress local capacity building rather than top-down frameworks, standardized tools and guidelines. As other jurisdictions demonstrate alternative EBHC policy frameworks, more international comparison and mutual learning is needed. Author Affiliation: (1)Ewan Ferlie is in the Department of Management, King's College London. (2)Sue Dopson is at Said Business School, University of Oxford. (3)Louise Locock is in DIPEx, University of Oxford. (4)Louise FitzGerald is at the Manchester Business School, University of Manchester. Article History: Date received 25 November 2006. Date accepted 22 September 2007.

This article reports on a two-year, multi-method, qualitative study in two regional offices in the UK National Health Service of the changing role of the regional tier from the autumn of 1994. The nature of the changes from fourteen semi-autonomous regional health authorities to eight regional offices of the NHS Executive, whose staff became civil servants, are described together with the. way this reorganization changed the role and relationships of NHS Executive HQ, the regional offices and the field. By the end of our research in the autumn of 1996, the change from regional health authority to regional office had gone well in the two regional offices studied; they had become smaller organizations, had established closer working with HQ and believed they had more influence over policy, while retaining good relations with health authorities. Emerging issues from the changes and some of their implications are discussed, particularly the pressures towards greater centralization and the particular forms that these have taken, despite the aim, and in part the achievement, of greater devolution, and the cultural differences between the NHS and the civil service. We conclude by assessing what the future holds for regional offices, in the light of the recent NHS White Paper (Secretary of State for Health 1997)., There is a need for regional offices in the UK's National Health Service. There is a balance between control and complete autonomy with the presence of regional offices and officers. A lack of communication and a lack of organization could also develop if too many layers of command are removed.

Have generic management texts and associated knowledges now extensively diffused into public services organizations? If so, why? Our empirical study of English healthcare organizations detects an extensive presence of such texts. We argue that their ready diffusion relates to two macro-level forces: (i) the influence of the underlying political economy of public services reform and (ii) a strongly developed business school/management consulting knowledge nexus. This macro perspective theoretically complements existing explanations from the meso or middle level of analysis which examine diffusion processes within the public services field, and also more micro literature which focuses on agency from individual knowledge leaders. [ABSTRACT FROM AUTHOR]