Understanding the role of opinion leaders in improving clinical effectiveness

We present findings from evaluations of two government-funded initiatives e xploring the transfer of research evidence into clinical practice - the PAC E Programme (Promoting Action on Clinical Effectiveness), and the Welsh Cli nical Effectiveness Initiative National Demonstration Projects. We situate the findings within the context of available research evidence from healthc are and other settings on the role of opinion leaders or product champions in innovation and change - evidence which leaves a number of problems and u nanswered questions. A major concern is the difficulty of achieving a singl e replicable description of what opinion leaders are and what they do - sub jective understandings of their role differ from one setting to another, an d we identify a range of very different types of opinion leadership. What m akes someone a credible and influential authority is derived not just from their own personality and skills and the dynamic of their relationship with other individuals, but also from other context-specific factors. We examin e the question of expert versus peer opinion leaders, and the potential for these different categories to be more or less influential at different sta ges in the innovation process. An often neglected area is the impact of opi nion leaders who are ambivalent or hostile to an innovation. Finally, we no te that the interaction between individual opinion leaders and the collecti ve process of negotiating a change and reorienting professional norms remai ns poorly understood. This raises a number of methodological concerns which need to be considered in further research in this area. (C) 2001 Elsevier Science Ltd. All rights reserved.