Transcript wider systems barriers: (targets and other performance

If it’s such a great idea,
why isn’t everybody doing it?
Barriers to evidence based commissioning
Rosemary Rushmer
Professor in Knowledge Exchange in Public Health
Teesside University
[email protected]
www.CartoonStock.com
Your Choices....
• What to commission?
• How to do that?
• What other factors to take into account?
What makes using evidence difficult: 1
The evidence itself
What is the evidence?
• Where is it?
• What’s good evidence?
• What are the actionable
messages?
• not independent
• not relevant to local conditions
• not answering the most pressing questions
when they need answering
What makes using evidence difficult: 2
The nature of public health and wellbeing issues
Public health & well-being issues are:
• Cross-cutting
• Entangled in multiple over-lapping social
conditions
• Long time-scales
• Problems establishing ‘cause-and effect’
• ‘Wicked problems’ (Rittel and Weber)
What makes using evidence difficult: 3
Your Organisation and how it works
Organisational factors
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Time and capacity
Roles and rules
Resourcing
Silo-working
• Professional identities and belief systems
• Tribalism
• Cynicism and apathy
What makes using evidence difficult: 4
The wider context
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Targets and other performance pressures
Changing demands and policy drives
Policy incoherence and lack of alignment
Overall ‘churn’ in the system
PLUS
Multiple types of knowledge
Research evidence may have to compete with
other types of local information (local knowhow, audits, organisational memory )
…which may seem more useful
AND
Contexts are not ‘power neutral’
Hierarchies, governance and politics
Power struggles – the exercise of power can distort
evidence use and practice.
Despite all that…..