Introduction: Knowledge and the Transformation of Health Care
This book is about the relationship between knowledge and the organisation of health care. Its aim is to propose an empirically robust conceptual model for the analytical exploration of this relationship. It takes as its point of departure the claim that knowledge-and the collective negotiation of what counts as such-has become central to the governance of health care services, programmes and systems. I suggest that current models used in the social sciences, and particularly in sociology, to understand health care change and reform are ill-equipped to conceptualise and understand the role of knowledge in institutional change. Instead of seeing knowledge as a resource used to advance or oppose processes of change, the book focuses on the interaction-the co-production-between knowledge-making and health care re-organisation. The ﬁ rst thesis of the book is that this process of co-production has been deployed through the overriding goals of effi ciency, eff ectiveness and involvement. The mobilisation of the ideals of the market, the laboratory and the forum, I argue, enabled articulations between different ways of knowing and moral conceptions of the role of health care in society. The second thesis of the book is to propose that the conﬂ icts and controversies that are usually sparked by health care change come not from instances of local resistance to suggested reforms but, in large part, from the frictions at the boundary between ideals and their implementation. This means that the key problem faced by health care researchers and health policy-makers is to understand and manage the tensions and synergies between these goals and ideals. This entails avoiding strategies that aim at reducing uncertainty or at ﬁ nding criteria for choosing one ideal over another, and instead attempting to establish ways of practically and institutionally exploring the complex, manifold realities of health care.