It was good to read the article on clinical audit staff measuring their performance ('Watching the detectives', pages 26-7, 27 January), but it was not a surprise that audit on its own was not seen as a prime motivator for change.

There are many reasons why this may be so. One that is often ignored is the different ways evidence is generated and viewed.

Clinical audit can reveal interesting and apparently pertinent information. It may seem that it provides compelling evidence for change. But not everyone will view the 'evidence' in the same light. The evidence-based approach to healthcare needs more than data to provide evidence that is seen as relevant to the target audience.

This is true of management as well as clinical evidence. My organisation development work often involves producing 'evidence' on the current position. That 'evidence' is of no value to the organisation unless it is put into the context, culture and language of the organisation and the target audience. This is not done simply to please the target audience. It is to gain understanding and commitment to the findings and any proposed solutions. Without that understanding and commitment there is no progress.

In the first year of the evidence-based healthcare MSc course at Oxford University, two of the three terms are spent on communicating, introducing and implementing evidence-based practice.

Finding the evidence is only the first step to evidence-based management and clinical practice.

Kate Wortham