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Critical%20Issues%20in%20Knowledge%20Utilization%20and%20Health%20Policy-Making

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Critical Issues in Knowledge Utilization and Health Policy-Making Robert F. Rich, Ph.D. University of Illinois at Urbana-Champaign Donald Schon: Beyond the Stable ... – PowerPoint PPT presentation

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Title: Critical%20Issues%20in%20Knowledge%20Utilization%20and%20Health%20Policy-Making


1
Critical Issues in Knowledge Utilization and
Health Policy-Making
  • Robert F. Rich, Ph.D.
  • University of Illinois at Urbana-Champaign

2
Donald Schon Beyond the Stable State
  • A social system learns whenever it acquires
    new capacity for behavior but government as a
    learning system carries with it the idea of
    public learning a special way of acquiring new
    capacity for behavior, in which government learns
    for society as a whole. In public learning,
    government undertakes a continuing, directed
    inquiry into the nature, causes and resolution of
    our problems.
  • continued

3
Donald Schon Beyond the Stable State
(continuation)
  • If government is to solve new public
    problems, it must also learn to create the
    systems for doing so and to discard the structure
    and mechanisms grown up around old problems.
  • Because many sorts of social systems have
    governments, the requirements of public learning
    may not be limited to traditional political
    units the concept of public learning applies as
    well to institutions such as the church, labor
    unions, schools, welfare agencies, and business
    firms.

4
Donald Schon Beyond the Stable State
  • Because many sorts of social systems have
    governments, the requirements of public learning
    may not be limited to traditional political
    units the concept of public learning applies as
    well to institutions such as the church, labor
    unions, schools, welfare agencies, and business
    firms.

5
John W. Gardner
  • A society that is capable of continuous
    renewal will have effective internal
    communication among its diverse elements. We do
    not have that today. We are drowning in a torrent
    of talk, but most of it serves only to raise the
    noise level. Communication in a healthy society
    must be more than a flow of messages it must be
    a means of conflict resolution, a means of
    cutting through the rigidities that divide and
    paralyze a community.

6
Knowledge utilization, the social contract, and
the role of public learning (1)
  • What is the social contract? (This is a legal,
    political, economic, and social concept.)
  • The social contract (as it relates to the
    relationship between science and government)
    evokes the voluntary but mutual responsibilities
    between government and science, the production of
    the public good of basic research, and the
    investment in the future prosperity that is
    research. (Guston, 2000)
  • There has traditionally been an uneasy
    partnership between scienceespecially basic
    researchand government.

7
Knowledge utilization, the social contract, and
the role of public learning (2)
  • Scientists believe that it is in societys best
    interest to incorporate scientific knowledge into
    decision-making.
  • Policy-makers have posed a critical set of
    questions
  • What is the return on our investment?
  • What is the utility of the research that is being
    financed out of public funds?
  • How are these publicly financed research studies
    going to be used?

8
Knowledge utilization, the social contract, and
the role of public learning (2)
  • Is it science serving the needs of society or
    society serving the needs of science?
  • The adaptation of scientific knowledge to meet
    with needs of society is recurring in Western
    thought.
  • How does the social contract apply to knowledge
    inquiry systems in a knowledge society?
  • How has this changed over time? What is the
    relationship to public learning?

9
Examples of Public Learning
  • Public learning is a process by which citizens
    become engaged in the search for valid responses
    to a problematic issue or situation.
  • Such learning is a social phenomenainteracting
    with government agencies and other
    stakeholdersto frame the problem and then to
    become engaged in the process of formulating what
    to do about it.
  • Public learning involves changing attitudes and
    beliefs, which may lead to action indeed to
    behavior changes in society.

10
Focus of Knowledge Utilization
  • The knowledge inquiry systemWhat is the basic
    model?
  • The acquisition, distribution, utilization, and
    impact of knowledge on decision-making /
    policy-making
  • Decision-making can be made by individuals,
    organizations, (in the public and private sector)
    governments, and society.
  • The role of information / knowledge in the
    formulation of beliefs and attitudes and in
    motivating or driving actions.

11
Basic Assumptions
  • Information is collected for a variety of reasons
    and not necessarily for purposes of use
    information may be collected simply for building
    inventory or building capacity.
  • There may be negative, unintended consequences of
    using information.
  • It may be fully rational to ignore available
    information or to actively reject it.
  • Intended non-utilization is different from
    mis-utilization of information.

12
Different Types of Knowledge
  • Practical knowledge
  • Intellectual knowledge
  • Small talk or past-time knowledge
  • Spiritual knowledge
  • Unwanted knowledge
  • All of these types have implications for the
    operations of a knowledge inquiry system
  • The distinction between data, information, and
    knowledge

13
Common Myths
  • Acquiring information will automatically lead to
    its distribution and use.
  • Using basic research is a rational act.
  • The problem with policy-making or
    decision-making is that there isnt enough
    scientific information being used.
  • If we can bridge the gap between the two
    cultures, we will have solved the primary problem
    of translating research into action.
  • Use is use is use !
  • Use for decision-making is the same as
    organizational learning or public learning.

14
Special Issues in Health Care (1)
  • The growing complexity of technology and medicine
  • This technology has an ever growing influence on
    every-day life
  • Evidence-based medicine and health care
    decision-making is of growing importance
  • The general model of decision-making in health
    care is fundamentally different from
    decision-making in politics

15
Special Issues in Health Care (2)
  • Health policy more than many other areas relies
    on science and is, in many ways, guided by
    science
  • Telemedicine
  • Biotechnology
  • Molecular biology
  • Genetic screening and the development of
    diagnostic procedures
  • The human genome project
  • Therapeutic technology
  • Health economics

16
Special Issues in Health Care (3)
  • Is there some reason to believe that decisions
    that involve a heavy scientific or technical
    dimension should be handled differently than
    those that do not?
  • Legally the answer is no
  • Is there a differencethe answer is yes
  • Why is this the case?
  • What are the consequences?

17
Key Findings from Research (1)
  • Learning involves introspection and
    self-reflection, and the demands of the public
    sector usually do not encourage this type of
    behavior.
  • Public and private organizations tend to reward
    people for knowing and winning, and not for
    admitting they dont know. (Implications of
    this)
  • Knowledge is power to the bureaucrat does this
    conflict with the system of scientific
    publication?
  • The use of knowledge produces effects and not in
    a single effect.

18
Key Findings from Research (2)
  • The realities of the political policy-making
    process reinforce feelings of distrust and
    suspicion between the two communities.
  • To a great extent, bureaucrats credibility,
    prestige, and legitimacy are related to the
    reliance of their superiors on the information
    they provide. This has implications for the
    system used to produce and collect information.
  • Who provides the information (the source) is at
    least as important as the content of the
    information provided.

19
Key Findings from Research (3)
  • In health care, voting records on traditionally
    controversial issues like needle exchange
    programs directly oppose research demonstrating
    their public health value.
  • Government sponsored studies have concluded that
    needle exchange programs decrease HIV
    transmission and drug use yet, lawmakers have
    continued to ban federal funding for such
    programs. What is the basis for this seeming
    contradiction?
  • Use is not the same as dissemination or impact.

20
Key Questions (1)
  • What types of information are preferred over
    others?
  • To what extent do decision-makers take research
    into account?
  • To what extent does research influence or change
    a position the decision-maker is already
    predisposed to? (This has particular implications
    for health policy-making)
  • What are the characteristics of basic science
    that make it useful for decision-making?
  • How do lawmakers define their needs? Where does
    scientific knowledge fit in with these needs?

21
Theoretical and Empirical Issues
  • Developing an appropriate theoretical or
    conceptual framework
  • The theoretical frameworks which have been used
    are ALL problematic
  • Rational Actor
  • Two Communities
  • Communications Model
  • Bureaucratic Actor model

22
Measurement issues
  • There are also a key set of measurement issues
  • The input-output model
  • Linear models
  • Specifying the dependent variable
  • Defining what is meant by use
  • The problem with causality
  • The use of interviews
  • The use of citation analysis

23
Promising Areas for Research and Practice (1)
  • Organizational learningorganizations can also be
    thought of as having learning disabilities
  • Public learning
  • The role of e-government and d-government
  • The knowledge inquiry system and the use of
    technology ( i.e., e-mail, the internet,
    decision-support systems, artificial intelligence)

24
Promising Areas for Research and Practice (2)
  • Management of information
  • Processing errors and biases
  • The use and abuse of information by individuals
    and by organizations
  • Symmetries and asymmetries of information (this
    may be particularly relevant in the area of
    health care)

25
Conclusions and Implications (1)
  • In health care, understanding the use of
    scientific and technical knowledge continues to
    be a real challenge
  • Researchers and practitioners will not be able to
    advance much further if they continue to rely on
    the Two-Cultures metaphor or the rational actor
    model.

26
Conclusions and Implications (2)
  • Advances in technology have underscored the
    importance of
  • Channels for transmitting information
  • Increasing the speed and efficiency with which
    information can reach our desk
  • Resisting the temptation to allow the
    availability of technology to define the decision
    to be made
  • The utilization process is directly and
    measurably affected by the type of information
    that is available for purposes of potential
    utilization AND the area in which the information
    is being applied.
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