Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Douglas P. Ferraro

Number of Pages



Quality improvement efforts in healthcare services often center on influencing provider behavior through clinical practice guidelines and research evidence. Passive dissemination of such information has quite limited effects on medical practice. Active implementation strategies focus on translating knowledge into practice, at times recruiting local physicians as "opinion leaders" to act as change agents, champion the adoption of new practice parameters, and promote the diffusion of medical innovation; This study developed an instrument to identify neuromuscular specialists whose advice is valued by colleagues, thus extending and updating similar work among educationally influential community physicians by Hiss, Macdonald, and Davis (1978). Neuromuscular specialists from across the United States rated the importance of various traits of colleagues whose advice they seek on patient care problems. These traits denoted approachability (pleasant personality), declarative knowledge (factual information), procedural knowledge (clinical skill), and translational ability (making clear how to apply information to clinical practice). As hypothesized, the respondents rated procedural, practical knowledge as most important. Also as expected, approachability was not as important to the specialists surveyed as it had been to general practitioners surveyed in the Hiss et al. (1978) research. The hypothesized high value of the advisor's ability to translate information, including research findings, into practice was not supported; Traits highlighting interest in the latest published research were not strongly endorsed. The finding that such interest was not a trait required of informal advisors is examined from the perspective of the cognitive psychology of expertise and experts' use of heuristics. The discussion includes recommendations for incorporating the procedural nature of clinical expertise in quality improvement efforts.


Advisors; Best Practices; Clinical Heuristics; Identifying; Informal; Informal Advisors; Medical Innovation; Neuromuscular; Neuromuscular Specialists; Specialists

Controlled Subject

Cognitive psychology; Medical sciences--Study and teaching; Health services administration

File Format


File Size

3788.8 KB

Degree Grantor

University of Nevada, Las Vegas




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