Knowledge transfer to policy makers(with apologies to John Lavis!)

Jeremy Grimshaw MD, PhDClinical Epidemiology Program, OHRI

Department of Medicine, University of OttawaCanada Research Chair in Health Knowledge Transfer and Uptake

• Evidence to support management and policy making

• Effects of KT strategies targeting managers and policy makers

• Current KT models targeting managers and policy makers

Overview

• 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

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

• Actionable messages

• Systematic reviews of research

• Individual studies, articles, and reports

•Basic, theoretical and methodological innovations

Background (4)

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?

• 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

Adapting Reviews (5)

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

• 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

• 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