Introduction/Objective: To promote clinical effectiveness and evidence based health care in a hospital setting.

Methods: A single English regional health authority funded public health specialists in a number of hospitals. The backgrounds of these staff and the environments in which they functioned varied considerably. Objectives for the post-holders included promoting clinical effectiveness, evidence based practice and the use of clinical guidelines; providing epidemiological support for audit, research, and the development of clinical outcome measures; and developing critical appraisal skills among hospital staff.

Results: Approaches varied with the particular skills of the post-holders and the contexts encountered. Material will be presented that reveals the complex nature of successfully implementing policies, which promote the uptake of evidence into practice. Innovations include establishing strategic groups with health care purchasers and providers to encourage a common focus and understanding between audit, research and education; developing local networked databases of evidence; providing methodological support to enable high quality audit and research; training staff in evidence based practice, critical appraisal, and effective implementation strategies. Barriers included limitations in time, money and understanding of the posts.

Discussion: These posts have provided an exciting opportunity to promote evidence-based practice among hospital staff. The lessons learned suggest that there is no quick fix for changing attitudes and practice. There appears to be no substitute for understanding and being actively involved in the detail of the organisational, political and clinical composition of the hospital.