Experience, evidence and everyday practice Creating systems for delivering effective health care By Michael Dunning, Gerrard Abi-Aad and David Gilbert King's Fund 124 pages £12.95

Books on evidence-based healthcare are often a bit of a turn-off. They rave excitedly about systematic reviews, meta analysis, numbers needed to treat, and randomised controlled trials but devote little or no space to the most important question of all - how do you do something with all this useful evidence to effect change and improve things for patients?

By contrast, this book is based on the work of the Promoting Action on Clinical Effectiveness programme run by the King's Fund and financed by the NHS Executive. Between 1995 and 1998, 16 local projects were set up to bring about changes in clinical practice in areas where the research evidence suggested that current care could be improved.

They tackled a diversity of topics such as continence, the management of stable angina, Helicobacter pylori eradication and acute back pain. But the methods in each project were broadly similar: seek out the evidence, examine and understand current practice, set clear objectives for changes to improve the effectiveness of care, put in place a well worked out strategy and action plan to achieve those changes and then monitor its implementation.

The book provides a short exposition of general lessons learned, but the bulk consists of accounts of each of the 16 projects and how they fared.

These make illuminating reading and there is probably more to be learned from those which failed (or at least those which admit to some failings) than from those that appeared to run smoothly from start to finish. Overcoming prosaic problems such as staff turnover, financial crises and the inevitable reorganisations proved more of a stumbling block than finding good research evidence or even securing clinicians' agreement to proposed changes.

The central message is one that most managers will be familiar with - that change is a costly and messy business, but it can happen if you have the right skills and support.

You may question whether we need a research project - or indeed a book - to tell us that. But it offers an insight into change that we rarely get from doing it ourselves.

The accounts of individual projects provide plenty of useful ideas from which to learn.

I hope Experience, Evidence and Everyday Practice will be read by those clinicians - especially some doctors - who denigrate the contribution managers make to healthcare organisations.

If so, it could bring home a salutary truth to them - that delivering good-quality clinical care and making improvements in care processes both demand, above all, good management.

We can deluge healthcare organisations and staff with evidence such as the ubiquitous Effective Health Care bulletins, but without the management skills to effect change, nothing will happen.

Kieran Walshe Senior fellow, health services management centre, Birmingham University.