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Engaging with Policy Makers to Conduct Policy Informing Health

Services Research

Alba DiCenso, RN, PhDProfessor

Nursing and Clinical Epidemiology and BiostatisticsMcMaster UniversityHamilton, Canada

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Application of Research Findings

“Unhealthy MedicineAll Breakthrough, No Follow-Through”

By Steven H. WoolfThe Washington Post

Sunday, January 8, 2006

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Application of Research Findings

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Clinical research: research that is intended to inform our clinical practice. Examples:

a clinical trial comparing two levels of closed system suction pressures in ICU patients

effects of a self-care program on quality of life in patients with a permanent pacemaker

Background

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Gap between research and clinical practice persists:

– Strong need for nursing leadership in organizations to support nurses in becoming evidence-based practitioners:

Create evidence-based culture(e.g., Best Practice Spotlight Organizations)http://rnao.ca/bpg/bpso

Background

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Make available and encourage use of evidence-based resources:

–e.g., up-to-date clinical practice guidelines–http://rnao.ca/bpg/guidelines–Practice guideline implementation toolkit–http://rnao.ca/bpg/resources/toolkit-

implementation-best-practice-guidelines-second-edition

Background

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Make available and encourage use of evidence-based resources. Example:

Nursing + Best Evidence for Nursing Care

–Free regular notification by email about recent studies that have been pre-rated for quality and are of clinical relevance to you

Background

WelcomeMcMaster University's Health Information Research Unit is

providing you with access to current best evidence from research, tailored to your own health care interests, to support

evidence-based clinical decisions.This service is unique: all citations (from over 120 premier clinical journals) are pre-rated for quality by research staff, then rated for clinical relevance and interest by at least 3

members of a worldwide panel of practicing nurses. Here's what we offer:

A searchable database of the best evidence from the medical literatureAn email alerting systemLinks to selected evidence-based resourceshttp://plus.mcmaster.ca/NP/Default.aspx

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– To explore the challenges in applying health services research findings to policy

– To describe components of a training program designed to prepare researchers to engage with policy makers

Objectives

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An individual charged with developing and implementing policy at the local, regional, provincial or national level (aka: decision maker)

e.g., Senior policy advisor in various government branches – nursing, primary care, cancer care, social services, education;Chief executive officer of a regional health authority;Senior manager in a hospital or health care agency;Administrator of a professional or regulatory body

Policy Maker

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Research that is intended to inform policy development and decision making regarding the governance, organization, funding, and delivery of health services, or the allocation of resources dedicated to improving health

e.g., how to best transition patients from cancer care to primary care

e.g., developing and evaluating a nurse case management role

Health Services and Policy Research

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Health Services Research Competencies

1.Understanding of the country’s healthcare system

2.Ability to conduct health services research

3.Understanding of population health theories

4.Understanding of theories of health and health services knowledge production

5.Ability to effectively exchange knowledge and develop research partnerships with stakeholders in the health field

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“In the world of research, completing the study is just the first step…making the research come alive and using it to build capacity for future science and scientists and to tell stories that capture policy-maker’s attention and ultimately lead to policy changes, are what it is all about”

O’Brien-Pallas, 2003

Potential Contribution of Research to Policy

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Complex forces compete with research for the attention of policy makers:– Interests of stakeholders– Values of the public– Ideologies of governing parties– Constraints of prior policy

Heavy work pressure with little time to read research reports/journal articles

Challenges in Applying Research Findings to Policy

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International emphasis on learning how to enhance linkage and exchange between researchers and policy makersNew world: decision maker partners want to base policy changes on evidencePartnering with researchers on policy relevant researchEngaging in training of future researchersApplying research findings to policy

Working with Policy Makers to Move Research into Policy

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“A collaborative form of inquiry in which academics and practitioners (policy makers) leverage their different perspectives and competencies to co-produce knowledge about a complex problem or phenomenon”

Leverages “the relative contributions and conceptual frameworks of researchers and practitioners (policy makers)”

Van de Ven AH & Johnson PE. Knowledge for Theory and Practice, Academy of Management Review. 2006;31(4):802-21.

Engaged Scholarship

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Collaborative Research(Denis & Lomas, 2003)

“a deliberate set of interactions and processes designed specifically to bring together those who study societal problems and issues (researchers) with those who act on or within those societal problems and issues (policy makers, practitioners, citizens)

Denis, J-L., Lomas, J. (2003). Convergent evolution: the academic and policy roots of collaborative research. Journal of Health Services Research & Policy. 8(S2):1-6.

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Engagement of policy maker in research beginning to end

Policy placements

Science policy fellowships

Knowledge translation coursesPreparation of policy briefs to convey research

Involvement of policy makers in health services associations, conferences, journals, publicationsTraining of policy makers in evidence use

Strategies to Build Researcher –Policy Maker Linkages

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Early and ongoing involvement of policy makers in the research process is the best predictor of its utilization (Lomas, 2000)

Students required to partner with a policy maker to help shape their question and to act as an ex officio member of the thesis committee

Lomas, J. (2000). Connecting research and policy. Canadian Journal of Policy Research, Spring, 140-144.

Engagement of Policy Makers in Research Beginning to End

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CIHR's Partnerships for Health System Improvement ProgramSupports teams of researchers and decision makers interested in conducting policy-relevant health services research that responds to the needs of health care decision makers and strengthens the Canadian health system.

The program requires meaningful collaboration between researchers and decision makers likely to make use of the results of the research.

Engagement of Policy Makers in Research Beginning to End

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Example: Improving Care in the Community for Cancer Survivors

Research Team includes:– Cancer survivors– University researchers– Clinicians– Patient and citizen advocates– Primary care and cancer care government leaders

from 3 provinces

Engagement of Policy Makers in Research Beginning to End

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Graduate students spend 200 hours in a policy setting to:

Gain understanding of the policy processIdentify factors that shape the policy-making environmentGain practical experience by actively contributing to an aspect of the policy process through collection, analysis, synthesis, or evaluation of policy-relevant informationGain skills in communicating relevant research findings to policy makers

Policy Placements

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Short-term policy assignments at Health Canada for academic researchers

– policy-makers have immediate access to researchers to engage on a public policy issue

– Researchers learn how government works and how public policies are made

The assignment must be focused on a specific policy project

Fellowships are for a period of six months, full-time

Science Policy Fellowships

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Objectives:

– To understand theoretical underpinnings of knowledge transfer/translation (KT)

– To identify creative KT interventions

– To learn scientific approaches to the evaluation of KT interventions

Knowledge Translation Courses

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Short clear language documents that present findings and recommendations of research projects to a non-specialized audience

Focus on one topic and can include one or more studies

1-2 pages in length

Policy Briefs

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Policy Brief Template

The issueThe purposeWhat did we do?What did we find?How will this research help?What’s nextBottom line

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Canadian Association for Health Services and Policy Research

Membership includes researchers, students and policy makersAttendance and presentation at annual conference by researchers, students and policy makers

Healthcare Policy JournalIncludes both researchers and policy makers as editors, editorial board members, peer reviewers, and authors

Involvement of Policy Makers in Health Services Research Forums

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Training of Policy Makers in Evidence Use

Executive Training for Research Application

Objective:

To provide health system senior executives across Canada with the opportunity to learn and apply a systematic approach to finding and applying research evidence to inform complex decisions and change strategies in healthcare organizations

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Training of Policy Makers in Evidence Use

Supported by: Canadian Nurses Association, Canadian Medical Association, Canadian Foundation for Healthcare Improvement, Canadian College of Health Leaders

• 14-month program with protected blocks of time by employer

• Mentorship by an academic and a decision-making mentor

• 4 weeks of away-from-home residency sessions on research-based evidence, change management, and systems thinking

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Training of Policy Makers in Evidence Use

Completion of an Intervention Project to guide a change strategy in their organization supported by research. Examples:

• Innovative Nursing Schedule Practices Supported by an E-Scheduling System

• Implementing a “Navigator” Model in Emerging Mental Illness

• http://www.chsrf.ca/WhatWeDo/EducationandTraining/EXTRA.aspx

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Benefits of Engaged Scholarship

– Opportunity to conduct policy relevant research

– Achieving change in the health system

– Keeping the research “grounded in reality”– Funding possibilities

– Connecting of policy makers with common issues

– Opportunity for long term relationship over length of a full research program

– Creation of trusting relationship for future research and consultation opportunities – develop reputation

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Challenges of Engaged Scholarship

Policy makers change positions frequentlyPolicy maker position could remain vacant for long timePolicy maker priorities change as result of political agendaTiming issues (too short or too long):– Policy maker wants answer yesterday– Takes time to navigate political process

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A Policy Maker’s View

“Moving government policy from the realm of opinion to evidence-informed policy formation requires the additive effect of scientists and policy makers collaborating to explore: 1) the right question; and, 2) the policy options that might address the question. The more knowledge we have, the better our ability to fully explore the boundaries of any particular policy problem and to propose a wider range of responses. This takes many minds, seeing the problem through different lenses, working together for a common purpose –formulating good, defensible public policy, founded on the best available evidence.”

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The Break-Even PointBreakthrough (results of high quality research) =

Follow-Through (successful application of findings to practice or policy)