Knowledge mobilisation in orthopaedic surgery in England: why hierarchies of knowledge bear little relation to the hierarchy of evidence in professionally socialised groups

Background: Healthcare policy encourages the use of scientific evidence in delivery healthcare services. However, complexity practice restricts codified knowledge clinical guidelines despite continued effort from policymakers to ensure their practice. This study adopts a mobilisation perspective explore multiple levels through which is enacted generate variation Aim: To how professionalised groups clinicians mobilised highly-professionalised and organisationally-regulated context orthopaedic surgery. Methods: Three contrasting NHS hospitals England were examined using case methods 2014–15. Data included 64 interviews with surgeons staff, nine months observation day-to-day practice, collection 121 supplementary documents. A multilevel thematic analysis cross-case comparison explored individual surgeons, professionals hospital organisations knowledge. Findings: The findings described three themes illustrate emerged: 1) professional identities; 2) acquisition; 3) contextual contingencies identified had significant influence on was within organisations. Conclusions: Knowledge owned by professionally socialised surgical central explaining observed Hierarchies surgery bore little relation hierarchy foundational production guidance guidelines. defined privileged surgeon carried weight generated contingent mobilisation.