Never mind solutions: what are the issues? Lessons of industrial technology transfer for quality in health care.

It is now accepted as a truism that quality in health care would substantially improve if only some way could be found to secure more comprehensive and systematic uptake of the findings of biomedical research and development through implementation in everyday clinical practice. The relationship between the communities of clinical practitioners and scientific researchers is at best, integrated; more usually, distant; and at worst, nonexistent. Each community can easily stereotype the other and use this as a justification for maintaining distance. Members of the medical research community can dismiss misguided practitioners who do not immediately acknowledge, let alone act on, what they see as the most persuasive of proven findings, which show how to improve the outcome of clinical interventions. In contrast, members of the clinical community, particularly when they are geographically or culturally far removed from postgraduate research centres, can dismiss the scientists for their "ivory tower" approach, which pays little attention to things which are really important to those at the front line of health provision. Clinicians are preoccupied with doing their clinical work in "tried and tested," "good enough" ways, which reflect the principles of their own education and training and the norms of practice for many of their respected colleagues. Practitioners are frequently unaware of the results of research and development and even if they are aware they are often sceptical about the feasibility of general application. Many reasons can be cited why it is impractical or unwise to seek to secure widespread applications of particular findings. The distant relationship between groups of practitioners and researchers has recently become the focus for attention of a third group, the commentators and researchers who focus on the relation between medical research and clinical practice. The endeavours of this third group have been given special impetus through the development of the National Health Service (NHS) research and development programme.' 2 This group's concern is to seek ways in which the gulf between practitioners and researchers can be bridged, yet there is a danger that in their approach they accept one, if not both, of the stereotypes. Although widespread concern about the relation of research to clinical practice in the health service is only comparatively recent, this is a concern which has been strongly evident in other scientifically based sectors of the economy for at least 30 years. A wealth of research commentary and action in managing innovation and technology transfer could usefully be taken as a basis for determining fruitful avenues for developing the relation between research and practice in the health sector. The aim of this paper is threefold: firstly, to summarise a review of the relation between research and practice undertaken for the then North West Thames region in spring 1994; secondly, to summarise some of the lessons from research and practice of technology transfer outside the health service; and, thirdly, to suggest ways of developing the agenda for research and action in implementation in health.