How do clinical networks as safety and quality stewards understand evidence and evidence use? A Q-methodology study

The use of appropriate evidence at the point of clinical care is central to assuring safety and quality of health services. Yet practitioners, institutions, and government departments still grapple with understanding what evidence-based care is and what strategies should be employed to accelerate evidence use. Clinical networks have been established across all Australian states to define care expectations and facilitate improvements in clinical care. While the work of clinical networks is to be evidence-based, understandings of what this means in practice remains challenging, open to a range of interpretations. This research examines the determinants of evidence use by clinical networks as safety and quality stewards through the conduct of a Q-methodology study within the Australian state of Victoria. Q-methodology undertakes a holistic examination of participant viewpoints through quantitative analysis of qualitative data. Predominately used in health and social sciences research, Q-methodology allows for the examination of the subjective dimensions of tacitly understood issues. Informed by the literature, Q-methodology study domains included network management, participation, evidence types, and evidence use processes. Stratified purposeful sampling was conducted across three clinical networks ( n = 26). Participants varied in role and professional background. Participants also had varied tenure in their role with clinical networks. Details of tenure were also collected to assist with the interpretation of the Q-sort. Q-method data intercorrelation and by-person factor analysis was conducted through which four factors emerged. Rotated factors represented 45 per cent of the study variance and construct validity was demonstrated. Full factor interpretations of viewpoints were developed. Viewpoint one revealed that scientific understanding of evidence focuses stewardship to clinical practice issues and authoritative use of evidence to guide practice. Medical professionals tended to align with Viewpoint one, which accords with the tenets of evidence-based medicine. Nursing and other disciplines aligned to viewpoints two and three, which reflected a pragmatic and vision-centred approach to evidence use. Viewpoint four placed value on knowledge and learning. Evidence-based stewards seek to influence diverse and autonomous actors through trust where other forms of power and control may be less effective. Clinical networks are grounded in positivist principles and logic, integrating skills in pragmatism and strategy to advance population health outcomes. Q-methodology is shown to be an effective method to explore ill-defined concepts within multidisciplinary and intersectoral structures.