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

1
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

2
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

3
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 Ive
  taken?)

4
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)

5
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

6
Background (4)

• Actionable messages
• Systematic reviews of research
• Individual studies, articles, and reports
• Basic, theoretical and methodological innovations

7
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

8
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

9
Adapting Reviews (3)

• Changing the types of information profiled in a
  systematic review (2)
• Provide information about the contextual factors
  that may influence a reviews local applicability
• Highlight key features
• Reviews relative importance to health problem
• Relevance of outcome measures
• Practicality of the intervention
• Appropriateness of the intervention
• Cost-effectiveness of the intervention

10
Adapting Reviews (4)

• Changing the types of information profiled in a
  systematic review (3)
• Provide information about the contextual factors
  that may influence a reviews 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?

11
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

12
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

13
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

14
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

15
Knowledge translation models

• Push
• Pull
• Linkage and exchange
• Knowledge brokers

16
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

17
Push models (2)

• Multiple approaches targeting different
  stakeholder groups
• Peer reviewed papers
• Policy briefings (1, 3, 25)
• Toolkits

18
Pull models

• Increase demand from decision makers
• Enhancing receptor capacity
• Critical appraisal skills
• EXTRA training program
• Policy maker secondments

19
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

20
Knowledge brokers

• Using knowledge brokers to build and nurture
  relationships between those involved in joint
  knowledge production (researchers and policy
  makers)

21
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

22
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