Epistemology, evidence and experience: evidence based health care in the work of Accident Alliances

Evidence based health care has attracted considerable interest from NHS commissioners, public health specialists and sociologists as both a rational approach to decision making and as representing an ideological shift in health care. This paper explores the social construction of ‘evidence’ in one arena, that of the work of Accident Alliances. Interviews with key participants and observations of meetings suggest a high level of consensus that evidence was important for their work in terms of strategic decision making, operational planning and evaluation. However, evidence was framed differently across the professions and organisations involved in the alliances. Rather than being a neutral tool used to inform decision making, evidence was both constructed through professional practice and contributed to the construction of professional identity. The formal advocacy of evidence based interventions makes explicit a number of potential conflicts in inter‐agency working, and Accident Alliances provide an illuminating case study of how these are managed in day‐to‐day working in health care.