Achieving clinical behaviour change: A case of becoming indeterminate

This paper is based on an empirical study of attempts to achieve change in clinical behaviour across a United Kingdom National Health Service (NHS) He alth Authority (HA). We suggest that the evidence based medicine (EBM) move ment underpinning such attempts is premised upon a highly rationalistic con ception of change. Here the generation and implementation of research findi ngs into clinical practice is understood as movement between discrete entit ies. Drawing upon poststructural philosophy, social studies of science and technology, social anthropology, and gender studies, we challenge such line ar perspectives through a more immanent alternative. We conceive of change as movement within indeterminate or ambiguous relationships. We then procee d to discuss the implications of this modality for the management of clinic al behaviour change. (C) 1998 Elsevier Science Ltd. Bill rights reserved.