The Social Organization of Best Practice / Progress in Mathematics (PDF)

'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, Queen's University Belfast, Ireland

'Webster's 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.'

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 Smith's understanding of the social organization of knowledge, allowing for an examination of the complex social relations organizing people's 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.