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Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care
Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands.
Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands. (ValueS)ORCID iD: 0000-0003-3008-1297
Institute of Health Policy and Management, Erasmus University Rotterdam, the Netherlands.
2014 (English)In: Science as Culture, ISSN 0950-5431, E-ISSN 1470-1189, Vol. 23, no 2, 153-176 p.Article in journal (Refereed) Published
Abstract [en]

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.

Place, publisher, year, edition, pages
Routledge, 2014. Vol. 23, no 2, 153-176 p.
Keyword [en]
diagnostic work, evidence-based guidelines, problem behaviour, elderly care
National Category
Cultural Studies
URN: urn:nbn:se:liu:diva-111210DOI: 10.1080/09505431.2013.809411ISI: 000335212200001OAI: diva2:754650

Contributors to this Issue:

Teun Zuiderent-Jerak is LiU Research Fellow at the Department of Thematic Studies–Technology and Social Change of Linko¨ping University, Sweden (contact: At the time this article was accepted, he was Associate Professor of Science and Technology Studies at Erasmus University Rotterdam. He obtained his PhD in Science and Technology Studies from the Erasmus University Rotterdam in 2007. His research focuses on standardization and quality improvement practices in healthcare, the construction of markets for public values, and STS research that explicitly aims to ‘intervene’ in the practices it studies. He has published articles in the academic journals Social Studies of Science, Science, Technology, and Human Values, Social Science & Medicine, Human-Computer Interaction, Science as Culture, BMJ Quality and Safety, and the British Medical Journal. He has also co-edited a special issue of Science as Culture on Unpacking ‘Intervention’ in Science and Technology Studies. His book Situated Intervention; Sociological Experiments in Healthcare is forthcoming at The MIT Press.

Available from: 2014-10-10 Created: 2014-10-10 Last updated: 2015-05-04Bibliographically approved

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