Supporting Research Use by Health System Managers and Policymakers 8 January 2009 Supporting Research Use by Health System Managers and Policymakers Knowledge Translation (KT) Canada Lecture Series Videoconference Toronto, ON, Canada

Learning Objectives 1. What do we know about supporting research use by health system managers and policymakers? 2. What are the challenges that such efforts are striving to overcome? 3. What are some innovative strategies that are being developed and evaluated?

Supporting Research Use by Health System Managers & Policymakers Increasingly efforts to support research use strive to address the two factors that emerged with some consistency in a systematic review of the factors that increased the prospects for research use Interactions between researchers and policymakers Engage policymakers in priority-setting, research (including reviews), and deliberative dialogues Timing / timeliness Facilitate retrieval of optimally packaged, topical systematic reviews and review-derived products (e.g., one-stop shopping, training workshops, rapid response units)

Supporting Research Use by Health System Managers & Policymakers (2) process ► Policy- making process Policy- making process Unlinked asynchronous processes Research process ► ◄ ◄ Fortuitously linked processes Policy- making process Research process Knowledge- translation processes ◄ ► ► Purposefully linked processes

Supporting Research Use by Health System Managers & Policymakers (3) Such efforts need to recognize that research evidence can play many roles in management and policymaking Helps to get problems on the agenda (i.e., what challenges should we focus on?) Helps to think about problems and solutions differently (i.e., how should we begin to approach this challenge?) Helps to solve particular problems at hand (i.e., what policy or action should we support?) Helps to justify a decision made for other reasons (i.e., how can we ‘sell’ the position we’ve taken?)

Challenges in Linking Research to Policy Research competes with many other factors in the policymaking process Research isn’t valued as an information input Research isn’t relevant Research isn’t easy to use

Addressing Challenge 1 Challenge 1 Research competes with many other factors in the policymaking process Institutional constraints (e.g., constitutional rules) Interest group pressure Citizens’ values Other types of information (e.g., experience) One option (among many) for addressing challenge 1 Improve democratic processes (but this is beyond the scope of most of us) or create “routine” processes (as many countries have done for new technologies)

Addressing Challenge 2 Challenge 2 Research isn’t valued as an information input One option (among many) for addressing challenge 2 Convince policymakers to place value on the use of research by highlighting examples from the past or from other jurisdictions where research made the difference between policy success and policy failure

Addressing Challenge 3 Challenge 3 Research isn’t relevant One option (among many) for addressing challenge 3 Engage policymakers periodically in priority-setting processes and communicate the priorities to researchers (including short-term requirements for evidence briefs, medium-term term requirements for systematic reviews, and long-term requirements for new primary research)

Addressing Challenge 4a Research isn’t easy to use Challenge 4a Research isn’t communicated effectively (i.e., policymakers hear noise instead of music) One option (among many) for addressing challenge 4a Identify a high-priority issue, identify systematic reviews that address different facets of the issue, identify messages arising from the reviews, construct workable options for consideration, and send the resulting ‘evidence brief’ to policymakers - e.g., 27 reviews (1/6/6/14) re ACT to treat malaria

Review- derived products (e.g., evidence briefs) Systematic reviews of research Applied research studies, articles, and reports Basic, theoretical and methodological innovations

Addressing Challenge 4b Research isn’t easy to use Challenge 4b Research isn’t available when policymakers need it and in a form that they can use Two options (among many) for addressing challenge 4b Maintain a policymaker-targeted website that provides “one stop shopping” for optimally packaged, topical reviews (e.g., PPD/CCNC database) Provide policymaker training workshops that provide the knowledge and skills needed to find and use research evidence efficiently

PPD/CCNC database contains >800 systematic reviews about health system arrangements, plus review-derived products (www.researchtopolicy.ca/search/reviews.aspx) Summaries of systematic reviews (for more than half) E.g., SUPPORT summaries that grade the evidence and highlight local applicability, equity and scaling up considerations Overviews of systematic reviews E.g., Lancet articles on human resources for health and on primary healthcare (see reference list) Policy (or evidence) briefs E.g., HEN/Observatory briefs for European ministers

Policymaker training workshops address: 1) defining and framing problems, 2) identifying and characterizing policy and programmatic options, 3) identifying implementation challenges and characterizing implementation strategies (and soon will address characterizing performance monitoring, reporting and management strategies) Five-day version available through EXTRA Two-day version offered in a number of settings in Africa and Latin America One-day version offered at the Ontario Ministry of Health and Long-Term Care and at PAHO

Addressing Challenge 4c Research isn’t easy to use Challenge 4c Policymakers lack mechanisms to prompt them to use research in policymaking One option (among many) for addressing challenge 4c Propose changes to cabinet submissions and program plans to prompt policy analysts to summarize whether and how research informed the definition of a policy problem, the characterization of policy/programmatic options to address the problem, and the proposed approach to implementation

Addressing Challenge 4d Research isn’t easy to use Challenge 4d Policymakers lack fora where policy challenges can be discussed with researchers and stakeholders One option (among many) for addressing challenge 4d Plan deliberative dialogues at which pre-circulated evidence summaries serve as the starting point for off-the-record deliberations involving policymakers, stakeholders, researchers and others

Addressing Challenges in Supporting Research Use Research isn’t valued as an information input [General climate for research use] Research isn’t relevant [Production] Research isn’t easy to use [Translation] Research isn’t communicated effectively [Push] Research isn’t available when policymakers need it and in a form that they can use [Facilitating pull] Policymakers lack mechanisms to prompt them to use research in policymaking [Pull] Policymakers lack fora where policy challenges can be worked through with key stakeholders [Exchange]

Some Innovative Strategies that are Being Developed and Evaluated Producers / purveyors of research Users of research Push efforts Producers / purveyors of research Users of research User-pull efforts Producers / purveyors of research Users of research Knowledge-translation platforms Integrated efforts Producers / purveyors of research One group of users of research Exchange efforts

Some Innovative Strategies that are Being Developed and Evaluated (2) Push efforts Literature service drawing on the PPD/CCNC database (Canada, Brazil)* Evidence briefs (HEN/Observatory, EVIPNet Africa, EVIPNet Asia/ Asia-Pacific Observatory, Canada) Efforts to facilitate user-pull PPD/CCNC database Training workshops Exchange efforts Deliberative dialogues (EVIPNet, Canada)* Integrated efforts Knowledge-translation platforms (EVIPNet)*

References Lavis JN, Davies HTO, Oxman A, Denis J-L, Golden-Biddle K, Ferlie E. Towards systematic reviews that inform healthcare management and policymaking. Journal of Health Services Research and Policy 2005; 10 (supplement 1): 35-48 [contains the systematic review] Lavis JN, Lomas J, Hamid M, Sewankambo N. Assessing country-level efforts to link research to action. Bulletin of the World Health Organization 2006; 84(8):620-628 [contains the framework]

References (2) Lewin S, Lavis JN, Oxman AD, Bastias G, Chopra M, Ciapponi A, Flottorp S, Garcia Marti S, Pantoja T, Rada G, Souza N, Treweek S, Wiysonge CS, Haines A. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: An overview of systematic reviews. The Lancet 2008; 372: 928-939. [An example of an overview that draws on the typology and contents of the PPD/CCNC database]