Transcript Milbank Consortium Population Health Webside

Knowledge transfer to policy makers
(with apologies to John Lavis!)
Jeremy Grimshaw MD, PhD
Clinical Epidemiology Program, OHRI
Department of Medicine, University of Ottawa
Canada Research Chair in Health Knowledge Transfer and Uptake
Overview
• Evidence to support management and policy
making
• Effects of KT strategies targeting managers and
policy makers
• Current KT models targeting managers and
policy makers
Background
• What is the place for research evidence in management
and policymaking?
• Helps to get problems on the agenda (i.e., what issue
should I focus on?)
• Helps to think about problems and solutions
differently (i.e., how should I begin to approach this
issue?)
• Helps to solve particular problems at hand (i.e., what
program or policy should I support?)
• Helps to justify a decision made for other reasons
(i.e., how can I sell the position I’ve taken?)
Background (2)
• Systematic reviews of research evidence
• Reduce the likelihood that managers & policymakers
will be misled by research (by being more systematic
and transparent in the identification, selection,
appraisal and synthesis of studies)
• Increase confidence among managers &
policymakers about what can be expected from an
intervention (by increasing number of units for study)
Background (3)
• Systematic reviews of research evidence (2)
• Allow managers, civil servants and political staff to
focus on appraising the local applicability of
systematic reviews and on collecting and synthesizing
other types of evidence, such as evidence about
political acceptability and feasibility – i.e., allow them
to focus on the apex of the research knowledge
pyramid while doing the rest of their jobs
• Allow for more constructive contestation of research
evidence by stakeholders
Background (4)
•Actionable messages
•Systematic reviews of research
•Individual studies, articles, and reports
•Basic, theoretical and methodological innovations
Adapting Reviews
• Two types of adaptations would enhance the usefulness
of the global stock of systematic reviews
• Changing the types of information profiled in a
systematic review
• Developing “friendly front ends” for reviews that would
allow rapid scanning for relevance and then graded
entry to highly relevant reviews
Adapting Reviews (2)
• Changing the types of information profiled in a systematic
review
• Provide ‘bread and butter’ information
• Harms (or risks) and costs of interventions (not just
the benefits)
• Uncertainty associated with estimates
• Differential effects by sub-group
Adapting Reviews (3)
• Changing the types of information profiled in a systematic
review (2)
• Provide information about the contextual factors that
may influence a review’s local applicability
• Highlight key features
• Review’s relative importance to health problem
• Relevance of outcome measures
• Practicality of the intervention
• Appropriateness of the intervention
• Cost-effectiveness of the intervention
Adapting Reviews (4)
• Changing the types of information profiled in a systematic
review (3)
• Provide information about the contextual factors that
may influence a review’s local applicability (2)
• Prompt managers & policymakers to ask the right
questions
• Could it work in my jurisdiction?
• Will it work?
• What would it take to make it work?
• Is it worth it?
Adapting Reviews (5)
• Developing “friendly front ends” for reviews
• For example, one page of take-home messages and
a three-page executive summary
• Facilitates rapid assessments of the relevance of a
review and, when the review is deemed highly
relevant, more graded entry into the full details of the
review
Implications
• For health system managers and policymakers who are
interested in systematic reviews
• Develop the skills to acquire, assess, adapt and
apply systematic reviews
• Become involved in the review process or at least
push for the profiling of decision-relevant information
in reviews
Effects of KT strategies targeting
policy makers and managers
• Health policy-makers perceptions of their use of evidence:
a systematic review
• 24 studies involving 2014 interviews with health policy
makers
• Most studies focused on hypothetical scenarios or
retrospective perception of the use of evidence in relation
to specific cases.
Innvaer, Vist, Trummald, Oxman (2002). Journal of Health Services Research and Policy
Effects of KT strategies targeting
policy makers and managers
• Facilitators
• Personal contact (13/24)
• Timely relevance (13/24)
• Inclusion of summaries with policy recommendations
(11/24)
• Barriers
• Absence of personal contact (11/24)
• Lack of timeliness or relevance of research (9/24)
• Mutual mistrust (8/24)
• Power and budget struggles (7/24)
Innvaer, Vist, Trummald, Oxman (2002). Journal of Health Services Research and Policy
Knowledge translation models
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Push
Pull
Linkage and exchange
Knowledge brokers
Push models (1)
Improving dissemination by researchers
• Five key questions
• What should be transferred?
• To whom should research knowledge be transferred?
• By whom should research knowledge be transferred?
• How should research knowledge be transferred?
• With what effect should research knowledge be
transferred?
Lavis JN, Robertson D, Woodside JN, Mcleod CB, Abelson J (2003) Milbank Quarterly
Push models (2)
• Multiple approaches targeting different
stakeholder groups
• Peer reviewed papers
• Policy briefings (1, 3, 25)
• Toolkits
Pull models
• Increase demand from decision makers
• Enhancing receptor capacity
• Critical appraisal skills
• EXTRA training program
• Policy maker secondments
Linkage and exchange
• Creating new relationships between researchers and
policy makers to enhance mutual understanding and
develop partnerships for framing and conducting
research.
• Policy makers as partners as in grant applications:
matching funds to demonstrate commitment
Knowledge brokers
• Using knowledge brokers to build and nurture
relationships between those involved in joint
knowledge production (researchers and policy
makers)
Knowledge brokers
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Understanding of both the research and decision
making environments
Ability to find and assess relevant research
Entrepreneurial skills (networking, problem solving
skills, innovative solutions, etc)
Mediation and negotiation
Understanding of the principles of adult learning
Communication skills
Credibility…
Summary
• Systematic reviews and syntheses are valuable for
managers and policy makers
• Managers and policy makers need to consider likely
applicability of systematic reviews to their context
• Other factors influence management and policy maker
decisions
• Limited evidence base on how to do KT to policy makers
• Emergence of new models that need evaluation