Changing clinical practice: views about the management of adult asthma

A case study of clinical practice in adult asthma is presented. The case is part of a larger project, funded by the North Thames NHS Executive Researc h and Development Programme, that sought to explore the part played by clin icians in the implementation of research and development into practice in t wo areas: adult asthma and glue ear in children. The first case of glue ear in children was reported in a previous issue of this journal (Quality in H ealth Care 1999;8:99-107), Background information from secondary sources on the condition, treatment, and organisation and location of care is followed by an account of the resu lts of semistructured interviews with 159 clinicians. The findings are repo rted in two sections: clinical management and the organisation of care, and clinicians' accounts of what, why, and how they introduce changes into the ir practice. The way clinicians talk about their learning, their expressed views on acceptable practice, and their willingness to change were shown to be informed by construction of legitimate and sufficient evidence, respect ed colleagues, and accumulated individual experience. There was Little open acknowledgment of the influence of organisational factors in influencing p ractice. To investigate whether relationships between task performance and organisational arrangements found in other sectors apply to UK health, more robust measures by which performance can be evaluated are needed.