title: Power, professions and evidence-based guidelines: lessons from an organizational case study.
abstract: OBJECTIVE
  This paper addresses the issues of evidence-based practice (EBP) in relation to power, professionalism and the British National Health Service reforms.
  
  
  BACKGROUND
  There has been little discussion at organizational level over issues of professional boundaries, roles and tensions, which are inextricably linked with the drive for an evidence-based culture.
  
  
  METHODS
  The paper is a reflection on the findings of a recent case study, which examined the management and organization of an independent sector provider of mental health services in its drive to address issues of EBP.
  
  
  RESULTS
  New managerial hegemony had altered the balance of power within the organization, there was an extension of managerial surveillance, competing political relationships and a general decline in medical dominance.
  
  
  CONCLUSIONS
  Organizations should avoid 'personalizing' the debate on establishing a research-based culture. EBP requires structures to support it and groups representing the health care professions within the organization should be involved in identifying and making recommendations on EBP issues.
authors.affiliation: University of Nottingham, UK.
authors.forename: D
authors.initials: D
authors.lastname: Mitchell
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D019982:Organizational Case Studies; D015279:Organizational Culture; D011057:Politics; D011209:Power, Psychological; D017410:Practice Guidelines as Topic; D012106:Research; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom